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Montana rates for HCPCS A5113

Leg Strap; Latex Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $16.17 / $16.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.96 / $5.87 / $5.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.08 / $5.87 / $5.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $5.59 / $5.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $4.51 / $5.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.52 / $2.80 / $3.29