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Montana rates for HCPCS L5668

Addition To Lower Extremity Below Knee Molded Distal Cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.43 / $466.26 / $466.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.36 / $118.36 / $118.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $127.27 / $127.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.19 / $103.49 / $127.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.58 / $121.21 / $127.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.19 / $95.52 / $128.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.65 / $60.47 / $95.90