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Montana rates for HCPCS L5652

Addition to lower extremity, suction suspension, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.29 / $1,509.80 / $1,509.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.36 / $681.36 / $681.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.50 / $732.60 / $732.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.50 / $595.75 / $732.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.74 / $697.71 / $732.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.50 / $549.85 / $733.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.95 / $261.06 / $402.28