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Montana rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $245.47 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $281.84 / $346.74
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $323.59 / $630.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $630.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $331.13 / $524.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $263.03 / $346.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $251.19 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $165.96 / $257.04