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Montana rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,913.30 / $6,636.20 / $6,636.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,484.86 / $2,484.86 / $2,484.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $2,671.73 / $2,671.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.00 / $2,172.67 / $2,671.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,274.04 / $2,544.50 / $2,671.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.00 / $2,005.25 / $2,673.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.40 / $1,140.05 / $1,808.12