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Montana rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $15,135.61 / $19,952.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $23,988.33 / $23,988.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $19,498.45 / $23,988.33
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17,378.01 / $22,387.21 / $43,651.58
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,378.01 / $22,387.21 / $43,651.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $19,054.61 / $32,359.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $17,782.79 / $23,988.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $15,135.61 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $10,000.00 / $15,488.17