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Montana rates for HCPCS 25490

Proph Tx N/P/Pltwr W/Wo Methylacrylate Radius

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.71 / $1,012.55 / $3,766.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,152.03 / $1,152.03 / $1,152.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.15 / $1,138.73 / $1,152.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.50 / $784.44 / $1,152.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.26 / $1,138.73 / $1,500.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$974.78 / $1,197.70 / $1,327.36