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Montana rates for HCPCS 27558

Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstruction

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.78 / $1,657.23 / $6,215.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,877.63 / $1,877.63 / $1,877.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.37 / $1,877.63 / $2,012.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$928.40 / $1,276.55 / $1,877.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.98 / $1,877.63 / $2,468.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,622.90 / $1,962.33 / $2,265.77