go back

Montana rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,262.45 / $11,315.60 / $11,315.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,601.10 / $3,601.10 / $3,601.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $3,871.91 / $3,871.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.78 / $3,148.67 / $3,871.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,639.91 / $3,687.53 / $3,871.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.78 / $2,906.03 / $3,874.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,326.30 / $1,467.45 / $2,327.36