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Montana rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.22 / $860.91 / $860.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $234.98 / $234.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.18 / $234.98 / $234.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.77 / $223.79 / $234.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.36 / $180.27 / $262.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.91 / $111.65 / $177.07