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Montana rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.59 / $2,145.54 / $2,145.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $1,041.08 / $1,041.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.41 / $1,041.08 / $1,041.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.59 / $991.51 / $1,041.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.12 / $784.51 / $1,041.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.30 / $370.99 / $571.67