go back

Montana rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,671.87 / $12,735.70 / $12,735.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $3,798.11 / $3,798.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.86 / $3,088.65 / $3,798.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.71 / $3,617.25 / $3,798.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,482.86 / $2,850.65 / $3,959.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,488.46 / $2,488.46 / $2,615.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.75 / $1,651.61 / $2,619.44