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Montana rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $89.13 / $141.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $102.33 / $125.89
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $117.49 / $229.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $117.49 / $229.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $120.23 / $194.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $95.50 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $91.20 / $95.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $60.26 / $93.33