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Montana rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $524.81 / $602.56
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $562.34 / $1,096.48
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $562.34 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $537.03 / $812.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $489.78 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $426.58 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $288.40 / $436.52