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Montana rates for HCPCS L5647

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.95 / $3,672.89 / $3,672.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.41 / $1,138.41 / $1,138.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $1,224.02 / $1,224.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.58 / $1,224.02 / $1,224.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.29 / $1,165.73 / $1,224.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.04 / $918.68 / $1,224.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.65 / $717.65 / $754.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.49 / $476.31 / $755.42