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Montana rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $131.83 / $194.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $186.21 / $229.09
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $213.80 / $416.87
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $213.80 / $416.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $204.17 / $263.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $173.78 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $131.83 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $87.10 / $134.90