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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
$18,216.34 / $63,182.40 / $63,182.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $23,816.40 / $23,816.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,513.81 / $23,816.40 / $23,816.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,174.41 / $22,682.29 / $23,816.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,513.81 / $17,875.27 / $23,833.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,037.45 / $9,999.21 / $15,858.68