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Montana rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.50 / $2,471.30 / $2,471.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $931.51 / $931.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.54 / $931.51 / $931.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$437.06 / $887.15 / $931.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.54 / $699.15 / $932.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.48 / $391.10 / $620.28