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Montana rates for HCPCS 43204

Esophagoscopy Flex Transoral Injection Varices

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.74 / $139.79 / $713.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.79 / $209.79 / $209.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.38 / $209.79 / $397.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.83 / $283.44 / $417.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.10 / $228.55 / $354.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.90 / $247.18 / $392.96