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Montana rates for HCPCS L6026

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,627.17 / $16,049.10 / $16,049.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $6,002.70 / $6,002.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,323.97 / $6,002.70 / $6,002.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $5,716.86 / $6,002.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,323.97 / $4,505.29 / $6,007.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,144.89 / $2,244.96 / $3,574.81