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Montana rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.40 / $1,902.08 / $1,902.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.80 / $664.80 / $664.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $714.80 / $714.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.96 / $581.27 / $714.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.56 / $680.76 / $714.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.96 / $536.48 / $715.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.82 / $302.95 / $480.49