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Montana rates for HCPCS L5611

Addition to lower extremity, endoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.66 / $6,862.86 / $6,862.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,517.96 / $2,517.96 / $2,517.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,226.77 / $2,707.32 / $2,707.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.77 / $2,201.62 / $2,707.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.14 / $2,578.40 / $2,707.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.77 / $2,031.97 / $2,709.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.96 / $964.75 / $1,486.65