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Montana rates for HCPCS L5987

All lower extremity prostheses, shank foot system with vertical loading pylon

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,050.97 / $24,455.90 / $24,455.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,573.83 / $8,573.83 / $8,573.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $9,218.58 / $9,218.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,042.00 / $7,496.65 / $9,218.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,325.26 / $8,779.60 / $9,218.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,042.00 / $6,918.96 / $9,225.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,498.11 / $3,870.38 / $5,964.13