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Montana rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$990.67 / $3,436.10 / $3,436.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $1,250.29 / $1,250.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.73 / $1,020.99 / $1,250.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.84 / $1,190.75 / $1,250.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.39 / $957.73 / $1,251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.21 / $545.71 / $865.48