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Montana rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $478.63 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $389.05 / $478.63
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $446.68 / $870.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $446.68 / $870.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $416.87 / $645.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $354.81 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $302.00 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $199.53 / $309.03