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Montana rates for HCPCS L6692

Upper Extremity Addition Silicone Gel Insert Or Equal Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.46 / $2,582.13 / $2,582.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.12 / $820.12 / $820.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.41 / $881.79 / $881.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.41 / $881.79 / $881.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.22 / $839.80 / $881.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.12 / $661.82 / $882.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.64 / $334.86 / $531.08