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Montana rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,956.31 / $10,253.79 / $10,253.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,065.70 / $3,065.70 / $3,065.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $3,296.24 / $3,296.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.89 / $2,680.54 / $3,296.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,623.78 / $3,139.28 / $3,296.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.89 / $2,473.96 / $3,610.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.25 / $1,453.01 / $2,239.04