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Montana rates for HCPCS L6647

Upper extremity addition, shoulder lock mechanism, body powered actuator

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $416.87 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $537.03 / $660.69
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,202.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $588.84 / $891.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $501.19 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $416.87 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $281.84 / $426.58