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Montana rates for HCPCS L7401

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.31 / $1,166.48 / $1,166.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.96 / $408.96 / $408.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $439.72 / $439.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.94 / $439.72 / $439.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.30 / $418.78 / $439.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.94 / $330.03 / $440.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $184.60 / $284.45