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Montana rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $2,137.96 / $2,630.27
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,454.71 / $4,786.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,454.71 / $4,786.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,905.46 / $2,884.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,949.84 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,412.54 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $933.25 / $1,445.44