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Montana rates for HCPCS L6930

Below elbow, 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
$5,128.61 / $6,606.93 / $8,511.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,309.57 / $10,715.19 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $8,709.64 / $10,715.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $10,000.00 / $19,498.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $10,000.00 / $19,498.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $8,511.38 / $12,302.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $8,128.31 / $10,715.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,025.60 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,981.07 / $6,165.95