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Montana rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.13 / $1,439.88 / $1,439.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.46 / $427.46 / $427.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $459.61 / $459.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.77 / $373.75 / $459.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.28 / $437.72 / $459.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.77 / $344.95 / $459.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.76 / $217.69 / $345.26