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Montana rates for HCPCS L5200

Above Knee Molded Socket Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,006.83 / $13,897.50 / $13,897.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $4,163.22 / $4,163.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,728.17 / $4,163.22 / $4,163.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,210.56 / $3,964.97 / $4,163.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,124.68 / $3,193.93 / $4,646.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.82 / $1,978.08 / $3,137.22