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Montana rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.68 / $1,521.56 / $1,521.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.00 / $515.00 / $515.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $553.73 / $553.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.53 / $450.30 / $553.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.02 / $527.36 / $553.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.53 / $415.59 / $554.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.79 / $263.08 / $405.42