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Montana rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.52 / $2,585.81 / $2,585.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.73 / $708.73 / $708.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $762.03 / $762.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.01 / $619.67 / $762.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.74 / $725.74 / $762.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.01 / $571.92 / $762.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.08 / $335.33 / $558.89