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Montana rates for HCPCS L5683

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socket Insert For Other Than Congenital Or Atypical Traumatic Amputee Siliconegel Elastomeric Or Equal For Use With Or Without Locking Mechanism Initial Only(For Other Than I Nitial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.28 / $4,471.79 / $4,471.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.90 / $1,570.90 / $1,570.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.52 / $1,689.03 / $1,689.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.52 / $1,373.54 / $1,689.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.08 / $1,608.60 / $1,689.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.52 / $1,267.70 / $1,690.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.79 / $707.89 / $1,122.70