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Montana rates for HCPCS 25909

Amputation, forearm, through radius and ulna; re-amputation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,047.13 / $1,148.15
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,202.26 / $1,412.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,202.26 / $1,412.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,023.29 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $933.25 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,122.02 / $1,288.25