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Montana rates for HCPCS L6624

Upper Extremi Addi, Flexion/Extens And Rotation Wrist Unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,691.37 / $12,803.30 / $12,803.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,941.06 / $4,826.18 / $4,826.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,941.06 / $4,826.18 / $4,826.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,941.06 / $4,596.35 / $4,826.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,574.59 / $3,702.54 / $4,829.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,831.34 / $2,026.24 / $3,122.37