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Montana rates for HCPCS L6715

Terminal Device Multiple Articulating Digit Includes Motor(S) Initial Issue Or Replacement (Reinstated Code Previous Description Was Terminal Device Hook Dorrance Or Equal Model # 5xa (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,094.46 / $10,733.00 / $10,733.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,381.07 / $4,053.89 / $4,053.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,381.07 / $4,053.89 / $4,053.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,381.07 / $3,860.85 / $4,053.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,381.07 / $3,042.62 / $4,056.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.89 / $1,699.03 / $2,694.65