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Montana rates for HCPCS L5646

Addition to lower extremity, below knee (BK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $489.78 / $741.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $724.44 / $891.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,621.81
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,621.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $676.08 / $1,023.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $676.08 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $489.78 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $331.13 / $501.19