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Montana rates for HCPCS L5988

Addition to lower limb prosthesis, vertical shock reducing pylon feature

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,958.06 / $6,791.45 / $6,791.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,380.88 / $2,380.88 / $2,380.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $2,559.92 / $2,559.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.19 / $2,081.77 / $2,559.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.11 / $2,438.02 / $2,559.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.19 / $1,921.34 / $2,561.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.42 / $1,074.80 / $1,656.24