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Montana rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,684.23 / $9,310.11 / $9,310.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $2,929.03 / $2,929.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.07 / $2,929.03 / $2,929.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,555.24 / $2,789.55 / $2,929.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,198.36 / $2,247.09 / $3,191.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.82 / $1,391.68 / $2,144.53