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Montana rates for HCPCS L5826

Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.92 / $10,616.60 / $10,616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,677.88 / $4,001.95 / $4,001.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,677.88 / $3,254.42 / $4,001.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,889.43 / $3,811.38 / $4,001.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,677.88 / $3,003.64 / $4,004.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,528.10 / $1,690.72 / $2,681.48