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Montana rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,388.44 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $5,370.32 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $4,365.16 / $5,370.32
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $5,011.87 / $9,772.37
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,011.87 / $9,772.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $4,786.30 / $7,244.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $4,073.80 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,388.44 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,290.87 / $3,467.37