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Montana rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,043.48 / $10,556.20 / $10,556.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,713.38 / $2,713.38 / $2,713.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $2,917.43 / $2,917.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.98 / $2,372.46 / $2,917.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,536.42 / $2,778.50 / $2,917.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.98 / $2,189.66 / $3,195.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.59 / $1,374.83 / $2,118.58