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Montana rates for HCPCS L5822

Addition Endoskeletal Knee-Shin System Single Axis Pneumatic Swing Friction Stance Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.22 / $5,897.13 / $5,897.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.82 / $2,373.62 / $2,373.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,367.82 / $1,930.26 / $2,373.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.51 / $2,260.59 / $2,373.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,367.82 / $1,781.51 / $2,375.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,536.34 / $1,536.34 / $1,614.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$921.60 / $1,019.68 / $1,617.20