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Montana rates for HCPCS L5632

Addition to lower extremity, Symes type, PTB brim design socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.94 / $818.37 / $818.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.93 / $319.93 / $319.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.52 / $343.99 / $343.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.52 / $279.73 / $343.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.58 / $327.61 / $343.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.52 / $258.17 / $344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.17 / $132.94 / $210.87