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Montana rates for HCPCS L5724

Addition Exoskeletal Knee-Shin System Single Axis Fluid Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,925.56 / $6,678.71 / $6,678.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.13 / $1,988.22 / $1,988.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.13 / $1,988.22 / $1,988.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,010.04 / $1,893.54 / $1,988.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.25 / $1,525.32 / $2,110.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.88 / $903.82 / $1,392.75