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Montana rates for HCPCS 49904

Omental flap, extra-abdominal (eg, for reconstruction of sternal and chest wall defects)

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,192.59 / $2,192.59 / $2,192.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.02 / $1,888.11 / $2,678.01