go back

Montana rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Facilitymedian $234 · 10th–90th $162–$3090%20%10th90th$234Professionalmedian $178 · 10th–90th $93–$2880%10%10th90th$178$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
$93.33 / $173.78 / $257.04
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $257.04 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $257.04 / $257.04
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $234.42 / $457.09
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $234.42 / $457.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $229.09 / $338.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $190.55 / $275.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $162.18 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $109.65 / $165.96