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Montana rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,674.87 / $16,214.60 / $16,214.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,249.00 / $4,901.91 / $4,901.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,249.00 / $3,986.29 / $4,901.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,349.89 / $4,668.49 / $4,901.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,249.00 / $3,679.10 / $4,905.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,900.50 / $2,102.75 / $3,334.95