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Montana rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,624.64 / $16,040.40 / $16,040.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $4,802.74 / $4,802.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,006.81 / $3,905.64 / $4,802.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.64 / $4,574.04 / $4,802.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,006.81 / $3,604.68 / $4,806.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,880.08 / $2,080.16 / $3,299.12