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Montana rates for HCPCS L5925

Addition, endoskeletal system, above knee (AK), knee disarticulation or hip disarticulation, manual lock

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.45 / $1,510.35 / $1,510.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.12 / $525.12 / $525.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.88 / $564.61 / $564.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.88 / $459.15 / $564.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.84 / $537.72 / $564.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.88 / $423.77 / $565.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.84 / $201.20 / $310.04