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Montana rates for HCPCS L5677

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.37 / $2,276.60 / $2,276.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.91 / $577.91 / $577.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $621.37 / $621.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.78 / $505.31 / $621.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.94 / $591.78 / $621.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.78 / $466.37 / $621.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.83 / $295.24 / $454.95