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Montana rates for HCPCS L6890

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.42 / $785.33 / $785.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.02 / $213.02 / $213.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $229.04 / $229.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.15 / $186.25 / $229.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.82 / $218.13 / $229.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.15 / $171.90 / $229.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $101.84 / $161.53