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Montana rates for HCPCS L5781

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system

Facilitymedian $4,786 · 10th–90th $3,020–$6,0260%20%10th90th$4,786Professionalmedian $3,090 · 10th–90th $1,514–$5,6230%10%10th90th$3,090$100.0$500.0$2.0K$10.0K

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
$1,513.56 / $2,884.03 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $5,128.61 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $5,128.61 / $5,128.61
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,786.30 / $9,332.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,786.30 / $9,332.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $4,570.88 / $6,918.31
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,890.45 / $5,128.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,235.94 / $3,388.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,137.96 / $3,311.31