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Montana rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.08 / $1,328.66 / $1,328.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.61 / $338.61 / $338.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $364.08 / $364.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.98 / $296.07 / $364.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.31 / $346.74 / $364.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.98 / $273.25 / $364.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.34 / $172.98 / $266.56