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Montana rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.12 / $902.20 / $902.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $274.04 / $274.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.10 / $231.85 / $274.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.50 / $260.99 / $274.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.68 / $225.10 / $274.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.18 / $196.18 / $206.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.68 / $130.21 / $206.50