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Montana rates for HCPCS L5984

All Endoskeletal Lower Extremity Prostheses Axial Rotation Unit With Or Without Adjustability (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.37 / $2,630.36 / $2,630.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.00 / $707.00 / $707.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.25 / $760.17 / $760.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.25 / $618.17 / $760.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.21 / $723.97 / $760.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.25 / $570.54 / $825.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.30 / $341.11 / $541.00