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Montana rates for HCPCS L5639

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.55 / $5,176.82 / $5,176.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $1,883.96 / $1,883.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.50 / $1,532.06 / $1,883.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.25 / $1,794.25 / $1,883.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.50 / $1,413.99 / $1,885.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.77 / $671.35 / $1,064.76