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Montana rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $407.38 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $524.81 / $645.65
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $602.56 / $1,174.90
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $602.56 / $1,174.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $575.44 / $870.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $489.78 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $457.09 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $309.03 / $467.74