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Montana rates for HCPCS L5855

Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $309.03 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $512.86 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $416.87 / $512.86
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $478.63 / $933.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $478.63 / $933.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $446.68 / $588.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $389.05 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $281.84 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $186.21 / $281.84