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Montana rates for HCPCS L5672

Addition to lower extremity, below knee (BK), removable medial brim suspension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.73 / $1,091.58 / $1,091.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.81 / $501.06 / $501.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.81 / $407.46 / $501.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.54 / $477.20 / $501.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.81 / $376.07 / $501.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $178.55 / $275.14