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Montana rates for HCPCS L5676

Additions to lower extremity, below knee (BK), knee joints, single axis, pair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.40 / $1,673.20 / $1,673.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.29 / $525.29 / $525.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.77 / $564.80 / $564.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.77 / $459.30 / $564.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.49 / $537.91 / $564.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.77 / $423.91 / $565.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.11 / $216.98 / $334.37