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Montana rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $645.65 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $870.96 / $1,071.52
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,949.84
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,949.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $891.25 / $1,096.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $812.83 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $575.44 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $380.19 / $588.84