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Montana rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Facilitymedian $389 · 10th–90th $309–$5500%20%40%10th90th$389Professionalmedian $288 · 10th–90th $158–$4900%10%20%10th90th$288$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $281.84 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $416.87 / $416.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $389.05 / $758.58
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $389.05 / $758.58
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $380.19 / $562.34
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $316.23 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $302.00 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $199.53 / $309.03