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Montana rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $457.09 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $977.24 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $794.33 / $977.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $707.95 / $1,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $691.83 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $524.81 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $346.74 / $537.03