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Montana rates for HCPCS L5979

All lower extremity prostheses, multiaxial ankle, dynamic response foot, one-piece system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,009.51 / $10,438.29 / $10,438.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.28 / $3,480.88 / $3,480.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.28 / $2,830.68 / $3,480.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,526.86 / $3,315.12 / $3,480.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.28 / $2,612.55 / $3,483.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.86 / $1,366.29 / $2,277.15