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Montana rates for HCPCS 20802

Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,467.37 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,801.89 / $4,677.35
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,677.35 / $5,011.87
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $4,677.35 / $5,011.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,630.78 / $5,495.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $3,801.89 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,365.16 / $5,128.61