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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
$806.13 / $2,796.02 / $2,796.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.36 / $788.95 / $788.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.36 / $663.69 / $788.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.91 / $751.38 / $788.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.14 / $644.36 / $829.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.80 / $374.86 / $577.64