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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
$61.97 / $214.93 / $214.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $76.06 / $76.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $61.85 / $76.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.18 / $72.44 / $76.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $57.09 / $76.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.65 / $30.59 / $48.52