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Montana rates for HCPCS L5651

Addition to lower extremity, above knee (AK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,199.02 / $4,158.76 / $4,158.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,876.81 / $1,876.81 / $1,876.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.11 / $2,017.94 / $2,017.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.11 / $1,641.02 / $2,017.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.61 / $1,921.85 / $2,017.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.11 / $1,514.56 / $2,019.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.92 / $719.09 / $1,140.48