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Montana rates for HCPCS L6925

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,495.60 / $29,466.60 / $29,466.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,261.93 / $11,026.65 / $11,026.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,261.93 / $11,026.65 / $11,026.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,155.71 / $10,501.57 / $11,026.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,276.00 / $8,459.41 / $11,034.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,169.75 / $4,613.50 / $7,316.97