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Montana rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.97 / $475.08 / $475.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $131.46 / $131.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.08 / $131.46 / $131.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.80 / $125.20 / $131.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.67 / $100.85 / $143.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.11 / $94.11 / $98.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.45 / $62.46 / $99.06