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Montana rates for HCPCS 25907

Amputation, forearm, through radius and ulna; secondary closure or scar revision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $954.99 / $1,023.29
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,071.52 / $1,258.93
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,071.52 / $1,258.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $891.25 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $831.76 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,174.90