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Montana rates for HCPCS 15842

Grf Facial Nrv Palyss Fr Muscle Flap Microsurg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,627.17 / $14,239.90 / $14,239.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,238.47 / $4,238.47 / $4,238.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,867.43 / $4,238.47 / $4,578.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,377.23 / $2,885.81 / $5,839.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,577.65 / $4,090.30 / $5,208.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,341.64 / $3,341.64 / $3,341.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,881.35 / $4,634.45 / $5,048.85