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Montana rates for HCPCS L5616

Addition to lower extremity, endoskeletal system, above knee (AK), universal multiplex system, friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.01 / $4,887.08 / $4,887.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $2,247.50 / $2,247.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.60 / $2,247.50 / $2,247.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.83 / $2,140.48 / $2,247.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.57 / $1,686.85 / $2,249.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.02 / $813.25 / $1,289.81