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Montana rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,023.29 / $1,698.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,737.80 / $2,137.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,890.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,890.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,862.09 / $2,454.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,548.82 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,148.15 / $1,230.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $776.25 / $1,174.90