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Montana rates for HCPCS L5728

Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,167.67 / $10,986.90 / $10,986.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.41 / $3,609.74 / $3,609.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,050.41 / $3,609.74 / $3,609.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,592.26 / $3,437.85 / $3,609.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,583.56 / $2,718.75 / $3,612.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.77 / $1,424.81 / $2,259.73