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Montana rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.82 / $1,303.51 / $1,303.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.49 / $488.49 / $488.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $525.22 / $525.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.26 / $427.12 / $525.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.30 / $500.21 / $525.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.26 / $394.20 / $525.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.78 / $217.72 / $345.30