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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
$446.68 / $588.84 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $933.25 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $758.58 / $933.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,698.24
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,698.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $831.76 / $1,258.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $691.83 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $588.84 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $389.05 / $602.56