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Montana rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,360.21 / $18,591.59 / $18,591.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $5,074.41 / $5,074.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,578.08 / $5,074.41 / $5,074.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,694.38 / $4,832.77 / $5,074.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,808.57 / $3,892.98 / $5,557.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.12 / $2,411.02 / $3,715.30