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Montana rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,349.15 / $28,958.60 / $28,958.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,652.12 / $10,894.15 / $10,894.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,652.12 / $10,894.15 / $10,894.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,142.47 / $10,375.37 / $10,894.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,652.12 / $8,176.55 / $10,902.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,159.04 / $4,601.64 / $7,091.00