go back

Montana rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.29 / $1,100.55 / $1,100.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.49 / $372.49 / $372.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $400.50 / $400.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.05 / $325.70 / $400.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.66 / $381.43 / $400.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.05 / $300.58 / $400.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.99 / $190.30 / $293.23