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Montana rates for HCPCS L8415

Prosthetic Sheath Upper Limb Each (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.91 / $82.93 / $82.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $29.83 / $29.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $24.25 / $29.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.34 / $28.41 / $29.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $22.39 / $31.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.60 / $12.83 / $20.36