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Montana rates for HCPCS 49426

Revision of peritoneal-venous shunt

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $724.44 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $851.14 / $1,995.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,148.15 / $1,288.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,148.15 / $1,288.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,071.52 / $1,737.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,047.13 / $1,348.96