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Montana rates for HCPCS L5705

Custom Shaped Protective Cover Above Knee

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.54 / $3,466.84 / $3,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.43 / $1,267.11 / $1,267.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.43 / $1,030.44 / $1,267.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.60 / $1,206.78 / $1,267.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.43 / $951.04 / $1,268.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.73 / $556.23 / $857.13