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Montana rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.63 / $1,674.00 / $1,674.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $608.46 / $608.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.82 / $514.80 / $608.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.08 / $579.49 / $608.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.68 / $499.82 / $650.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.59 / $435.59 / $457.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.30 / $289.10 / $458.52