go back

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
$1,702.71 / $5,905.80 / $5,905.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,983.08 / $1,983.08 / $1,983.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $2,132.19 / $2,132.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.22 / $1,733.94 / $2,132.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$859.42 / $2,030.67 / $2,132.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.22 / $1,600.32 / $2,133.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.07 / $769.04 / $1,219.69