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Montana rates for HCPCS L5962

Addition Endoskeletal System Below Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.49 / $2,714.03 / $2,714.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.68 / $877.68 / $877.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.56 / $943.68 / $943.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.56 / $767.41 / $943.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.33 / $898.74 / $943.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.56 / $708.27 / $944.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.11 / $351.96 / $542.36