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Montana rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.49 / $1,312.77 / $1,312.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.92 / $424.92 / $424.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $456.88 / $456.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.54 / $456.88 / $456.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.58 / $435.12 / $456.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.91 / $350.51 / $477.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.19 / $217.07 / $344.28