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Montana rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.79 / $1,889.59 / $1,889.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.46 / $662.46 / $662.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $712.28 / $712.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $712.28 / $712.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.18 / $678.36 / $712.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $534.59 / $712.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $299.04 / $474.28