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Montana rates for HCPCS L5658

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

Facilitymedian $490 · 10th–90th $347–$6170%20%10th90th$490Professionalmedian $363 · 10th–90th $145–$5750%20%10th90th$363$100.0$200.0$500.0$1.0K

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
$144.54 / $354.81 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $524.81 / $524.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $489.78 / $954.99
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $489.78 / $954.99
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $467.74 / $616.60
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $398.11 / $549.54
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