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Montana rates for HCPCS L6975

Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

Facilitymedian $21,878 · 10th–90th $13,804–$27,5420%20%40%10th90th$21,878Professionalmedian $12,589 · 10th–90th $7,244–$27,5420%20%10th90th$12,589$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,244.36 / $12,022.64 / $20,417.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13,803.84 / $23,988.33 / $23,988.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13,803.84 / $23,988.33 / $23,988.33
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17,378.01 / $21,877.62 / $42,657.95
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17,378.01 / $21,877.62 / $42,657.95
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,232.93 / $20,892.96 / $28,183.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $17,782.79 / $23,988.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,589.25 / $14,454.40 / $15,135.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8,709.64 / $9,549.93 / $14,791.08