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Montana rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.89 / $2,254.11 / $2,254.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.94 / $762.94 / $762.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $820.31 / $820.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.03 / $820.31 / $820.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.67 / $781.25 / $820.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.11 / $615.67 / $820.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.20 / $292.32 / $463.62