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Montana rates for HCPCS L5795

Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.20 / $3,864.54 / $3,864.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $1,353.12 / $1,353.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.11 / $1,353.12 / $1,353.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.47 / $1,288.69 / $1,353.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.58 / $1,038.08 / $1,410.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.08 / $642.91 / $1,019.65