go back

Montana rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.28 / $4,471.79 / $4,471.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,689.03 / $1,689.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.22 / $1,689.03 / $1,689.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.08 / $1,608.60 / $1,689.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.49 / $1,295.79 / $1,690.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.79 / $707.89 / $1,090.83