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Montana rates for HCPCS L6895

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.51 / $1,933.69 / $1,933.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.94 / $668.94 / $668.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $719.24 / $719.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.79 / $584.90 / $719.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.66 / $684.99 / $719.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.79 / $539.83 / $719.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.20 / $334.36 / $515.23