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Montana rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.18 / $2,296.71 / $2,296.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.37 / $777.37 / $777.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $835.83 / $835.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.63 / $679.69 / $835.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.85 / $796.03 / $835.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.63 / $627.33 / $836.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.20 / $297.85 / $496.41