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Montana rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Facilitymedian $676 · 10th–90th $447–$8320%20%40%10th90th$676Professionalmedian $479 · 10th–90th $219–$8320%10%10th90th$479$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $457.09 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $724.44 / $724.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $676.08 / $1,318.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $676.08 / $1,318.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $630.96 / $954.99
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $537.03 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $501.19 / $524.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $331.13 / $512.86