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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
$545.39 / $1,891.64 / $1,891.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $600.87 / $600.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.58 / $526.19 / $600.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.05 / $572.26 / $600.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.98 / $493.58 / $624.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.04 / $285.49 / $475.82