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Montana rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.66 / $2,150.21 / $2,150.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $674.48 / $674.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.57 / $548.50 / $674.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.62 / $642.36 / $674.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.57 / $506.22 / $703.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.56 / $364.85 / $364.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.03 / $278.85 / $464.75