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Montana rates for HCPCS L5780

Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.14 / $5,286.41 / $5,286.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.33 / $1,448.44 / $1,448.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.33 / $1,177.89 / $1,448.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.13 / $1,379.47 / $1,448.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.33 / $1,087.11 / $1,449.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.61 / $685.56 / $1,087.29