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Montana rates for HCPCS L5656

Addition To Lower Extremity Socket Insert Knee Disarticulation (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.82 / $1,712.79 / $1,712.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $482.41 / $482.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.84 / $482.41 / $482.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.23 / $459.44 / $482.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.07 / $370.10 / $528.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.75 / $222.12 / $342.28