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Montana rates for HCPCS L6691

Upper Extremity Addition Removable Insert Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.64 / $1,590.75 / $1,590.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.60 / $404.60 / $404.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.52 / $435.03 / $435.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.52 / $353.76 / $435.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.99 / $414.31 / $435.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.52 / $326.50 / $453.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.82 / $206.69 / $327.82