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Montana rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,778.28 / $2,137.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $3,890.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $3,890.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,905.46 / $2,951.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,621.81 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $1,445.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $912.01 / $1,412.54