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Montana rates for HCPCS L5814

Addition Endoskeletal Knee-Shin System Polycentric Hydraulic Swing Phase Control Mechanical Stance Phase Lock

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,640.17 / $12,625.70 / $12,625.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,426.38 / $4,426.38 / $4,426.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.67 / $4,759.24 / $4,759.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,502.67 / $3,870.25 / $4,759.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,232.98 / $4,532.60 / $4,759.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,502.67 / $3,572.02 / $4,762.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.95 / $1,998.13 / $3,079.07