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Montana rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $151 · 10th–90th $100–$1910%20%10th90th$151Professionalmedian $98 · 10th–90th $48–$1780%10%20%10th90th$98$50.0$100.0$200.0$500.0

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
$47.86 / $91.20 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $165.96 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $165.96 / $165.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $295.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $295.12
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $144.54 / $223.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $123.03 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $104.71 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $69.18 / $107.15