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Montana rates for HCPCS 63746

Removal of entire lumbosubarachnoid shunt system without replacement

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.39 / $801.54 / $3,068.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$989.03 / $989.03 / $989.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.41 / $989.03 / $1,032.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.14 / $610.17 / $989.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.00 / $984.04 / $1,277.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.80 / $974.40 / $1,113.59