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Montana rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,315.44 / $8,030.97 / $8,030.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $2,481.94 / $2,481.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,620.00 / $2,018.35 / $2,481.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.89 / $2,363.76 / $2,481.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,620.00 / $1,862.81 / $2,483.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.31 / $1,041.48 / $1,735.80