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Montana rates for HCPCS L5830

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,526.06 / $8,761.51 / $8,761.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.54 / $2,391.38 / $2,391.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,654.54 / $1,944.69 / $2,391.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.76 / $2,277.50 / $2,391.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,654.54 / $1,794.83 / $2,619.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.93 / $1,136.22 / $1,750.88