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Montana rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,921.75 / $13,602.40 / $13,602.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,768.80 / $4,768.80 / $4,768.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $5,127.41 / $5,127.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,886.72 / $4,169.66 / $5,127.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,405.71 / $4,883.25 / $5,127.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,886.72 / $3,848.35 / $5,131.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,945.66 / $2,152.71 / $3,317.27