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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
$2,919.89 / $3,807.79 / $14,309.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,322.08 / $4,322.08 / $4,322.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,890.34 / $4,322.08 / $4,644.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,136.91 / $2,938.25 / $4,261.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,622.94 / $4,322.08 / $5,675.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,475.01 / $4,454.22 / $5,041.24