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Montana rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Facilitymedian $102 · 10th–90th $69–$1320%20%40%10th90th$102Professionalmedian $78 · 10th–90th $41–$1290%10%10th90th$78$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
$40.74 / $75.86 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $109.65
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $199.53
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $199.53
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $102.33 / $138.04
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $72.44 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $47.86 / $74.13