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Montana rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.31 / $854.28 / $854.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $233.17 / $233.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.76 / $189.62 / $233.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.81 / $222.07 / $233.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.76 / $175.01 / $255.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.13 / $110.79 / $175.71