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Montana rates for HCPCS L6920

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,025.60 / $8,511.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $8,317.64 / $10,232.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $9,549.93 / $18,620.87
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $9,549.93 / $18,620.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $9,120.11 / $11,748.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $7,585.78 / $10,232.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,025.60 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,981.07 / $6,165.95