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Montana rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,561.81 / $12,354.00 / $12,354.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,331.07 / $4,331.07 / $4,331.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $4,656.77 / $4,656.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.80 / $3,786.92 / $4,656.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,184.90 / $4,435.02 / $4,656.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.80 / $3,495.11 / $4,660.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.07 / $1,955.12 / $3,100.81