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Montana rates for HCPCS L5250

Hip Disarticulation Canadian Type; Molded Socket Hip Joint Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,907.17 / $23,957.20 / $23,957.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,366.38 / $8,213.57 / $8,213.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,366.38 / $6,679.35 / $8,213.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,471.98 / $7,822.45 / $8,213.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,366.38 / $6,164.65 / $8,219.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,808.01 / $3,106.84 / $4,927.43