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Montana rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.87 / $370.67 / $370.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $110.24 / $110.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.21 / $89.64 / $110.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.72 / $104.99 / $110.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.21 / $82.74 / $112.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.45 / $48.07 / $76.23