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Montana rates for HCPCS L4110

Replace leather cuff KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.19 / $367.54 / $367.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.81 / $101.64 / $101.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.81 / $82.66 / $101.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.26 / $96.80 / $101.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.81 / $76.28 / $111.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.08 / $47.66 / $54.56