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Montana rates for HCPCS 43762

Perq Replacement Gtube Not Req Revj Gstrst Trc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.12 / $204.12 / $616.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.26 / $191.19 / $371.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.36 / $58.36 / $355.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.36 / $58.36 / $58.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.68 / $215.62 / $487.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $77.42 / $312.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.78 / $232.10 / $575.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.26 / $263.26 / $263.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.81 / $380.55 / $465.56