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Montana rates for HCPCS L5644

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $512.86 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $812.83 / $1,000.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,819.70
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $1,819.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $724.44 / $1,148.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $741.31 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $537.03 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $354.81 / $549.54