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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
$411.13 / $1,425.96 / $1,425.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $515.98 / $515.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.78 / $419.60 / $515.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.66 / $491.41 / $515.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.78 / $387.26 / $516.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.14 / $184.93 / $293.29