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Montana rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Facilitymedian $427 · 10th–90th $309–$6170%20%40%10th90th$427Professionalmedian $316 · 10th–90th $162–$5370%10%10th90th$316$100.0$200.0$500.0$1.0K$2.0K

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
$162.18 / $295.12 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $457.09 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $457.09 / $457.09
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $426.58 / $831.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $426.58 / $831.76
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $436.52 / $676.08
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $346.74 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $331.13 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $218.78 / $338.84