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Montana rates for HCPCS L5686

Addition to lower extremity, below knee (BK), back check (extension control)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $51.29 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $61.66 / $75.86
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $70.79 / $138.04
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $70.79 / $138.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $67.61 / $87.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $75.86 / $83.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $45.71 / $48.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $30.90 / $46.77