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Montana rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,064.24 / $17,565.09 / $17,565.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $6,392.30 / $6,392.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,853.06 / $5,198.27 / $6,392.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.61 / $6,087.90 / $6,392.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,853.06 / $4,797.70 / $6,396.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.79 / $2,277.89 / $3,510.16