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Montana rates for HCPCS L5702

Replacement, socket, hip disarticulation, including hip joint, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,783.74 / $20,060.59 / $20,060.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $6,578.68 / $6,578.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,745.37 / $6,578.68 / $6,578.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,907.28 / $6,265.41 / $6,578.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,937.59 / $5,047.02 / $6,617.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,351.30 / $2,601.52 / $4,125.99