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Montana rates for HCPCS L6915

Hand restoration (shading and measurements included), replacement glove for above

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $562.34 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $660.69 / $794.33
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,445.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $741.31 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $691.83 / $1,071.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $645.65 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $562.34 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $371.54 / $575.44