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Montana rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.82 / $1,411.04 / $1,411.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.81 / $390.81 / $390.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $420.20 / $420.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.16 / $341.71 / $420.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.92 / $400.19 / $420.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.16 / $315.38 / $442.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.48 / $198.59 / $314.95