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Montana rates for HCPCS 33764

Shunt Central W/Prosthetic Graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.33 / $1,466.05 / $6,732.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,054.30 / $2,054.30 / $2,054.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.25 / $2,054.30 / $2,054.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,054.30 / $2,364.05 / $2,480.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.24 / $1,775.45 / $2,711.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,854.87 / $2,284.19 / $3,591.77