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Montana rates for HCPCS 64738

Transection/Avulsion Inf Alveolar Nrv W/Osteo

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.88 / $619.91 / $2,415.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.83 / $709.83 / $709.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.95 / $709.83 / $771.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.82 / $483.76 / $709.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.28 / $709.83 / $928.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.54 / $753.99 / $835.20