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Montana rates for HCPCS 40801

Drg Absc Cst Hmtma Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.86 / $1,110.19 / $1,619.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.43 / $314.43 / $314.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.43 / $380.63 / $537.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.76 / $510.25 / $570.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.94 / $314.43 / $537.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.73 / $506.81 / $804.75