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Montana rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.10 / $1,224.70 / $1,224.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.89 / $310.89 / $310.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $334.27 / $334.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.07 / $271.83 / $334.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.49 / $318.35 / $334.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.07 / $250.88 / $366.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.55 / $158.83 / $244.74