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Montana rates for HCPCS 25924

Disarticulation Thru Wrist Re-Amputation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.08 / $1,007.97 / $3,665.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.99 / $1,140.99 / $1,140.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.42 / $1,138.97 / $1,140.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.10 / $774.26 / $1,140.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.29 / $1,138.97 / $1,498.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.37 / $1,116.15 / $1,273.30