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Montana rates for HCPCS L5613

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $3,235.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,890.45 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $3,162.28 / $3,890.45
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,630.78 / $7,079.46
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,630.78 / $7,079.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $3,388.44 / $4,365.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,884.03 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,187.76 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,479.11 / $2,238.72