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Montana rates for HCPCS 20805

Replantation Forearm Complete Amputation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,472.09 / $4,519.96 / $17,016.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,130.22 / $5,130.22 / $5,130.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,408.66 / $5,130.22 / $5,505.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,536.44 / $3,487.62 / $5,130.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,116.92 / $5,130.22 / $6,744.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,041.01 / $4,041.01 / $4,041.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,451.35 / $5,328.00 / $6,061.43