go back

Montana rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $245.47 / $323.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $389.05 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $316.23 / $389.05
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $363.08 / $707.95
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $363.08 / $707.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $346.74 / $537.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $295.12 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $251.19 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.96 / $257.04