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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
$174.82 / $606.35 / $606.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.84 / $214.84 / $214.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $231.00 / $231.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.00 / $187.84 / $231.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.90 / $220.00 / $231.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.00 / $173.38 / $231.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.18 / $87.61 / $135.00