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Montana rates for HCPCS L6621

Upper Extremity Prosthesis Addition Flexion/Extension Wrist With Or Without Friction For Use With External Powered Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,241.91 / $7,775.96 / $7,775.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,726.12 / $2,726.12 / $2,726.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $2,931.13 / $2,931.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.24 / $2,931.13 / $2,931.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.25 / $2,791.55 / $2,931.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.24 / $2,199.94 / $2,933.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.25 / $1,230.61 / $1,896.34