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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
$300.41 / $1,041.97 / $1,041.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.30 / $365.30 / $365.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $392.77 / $392.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.35 / $392.77 / $392.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.28 / $374.07 / $392.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.91 / $301.33 / $393.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.04 / $164.90 / $254.10