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Montana rates for HCPCS 21705

Division Scalenus Anticus Resection Cervical Rib

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.62 / $713.71 / $2,718.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.39 / $833.39 / $833.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.39 / $833.39 / $922.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.32 / $564.19 / $944.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.13 / $833.39 / $1,121.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.54 / $913.13 / $1,057.31