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Montana rates for HCPCS 19367

Breast Reconstruction Single Pedicled Tram Flap

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,725.52 / $9,332.37 / $9,332.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,786.21 / $2,786.21 / $2,786.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,972.63 / $2,786.21 / $2,991.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.12 / $3,095.95 / $3,344.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,693.20 / $2,540.06 / $3,663.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,429.14 / $3,038.49 / $4,889.55