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Montana rates for HCPCS L5050

Ankle, Symes, molded socket, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,162.28 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,570.40 / $3,162.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,951.21 / $5,754.40
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,951.21 / $5,754.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,754.23 / $4,073.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,344.23 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,089.30 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $2,137.96