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Montana rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,451.10 / $8,501.54 / $8,501.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $3,204.63 / $3,204.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.91 / $2,606.03 / $3,204.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,503.58 / $3,052.03 / $3,204.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.91 / $2,405.21 / $3,206.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,216.04 / $1,345.45 / $2,133.87