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Montana rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.39 / $1,576.00 / $1,576.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.53 / $552.53 / $552.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $594.08 / $594.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.03 / $483.12 / $594.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.74 / $565.79 / $594.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.03 / $445.89 / $594.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.44 / $249.43 / $384.36