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Montana rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.10 / $884.82 / $884.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.13 / $266.13 / $266.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $286.14 / $286.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.21 / $286.14 / $286.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.90 / $272.52 / $286.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.21 / $214.77 / $286.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.91 / $121.61 / $202.68