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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
$1,653.97 / $5,736.71 / $5,736.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $2,162.44 / $2,162.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.79 / $1,758.53 / $2,162.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,014.58 / $2,059.48 / $2,162.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.79 / $1,623.02 / $2,164.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.56 / $907.89 / $1,399.02