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Montana rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.34 / $2,713.54 / $2,713.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.09 / $888.09 / $888.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $954.87 / $954.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.15 / $776.51 / $954.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.14 / $909.40 / $954.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.15 / $716.67 / $955.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.63 / $400.12 / $616.57