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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
$7,443.91 / $25,818.80 / $25,818.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,541.83 / $10,223.69 / $10,223.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,541.83 / $8,314.00 / $10,223.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,465.81 / $9,736.85 / $10,223.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,541.83 / $7,673.33 / $10,231.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,611.78 / $3,996.14 / $6,337.86