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Montana rates for HCPCS 64755

Transection or avulsion of; vagus nerves limited to proximal stomach (selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly selective vagotomy)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.33 / $1,218.71 / $4,747.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,456.99 / $1,456.99 / $1,456.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.67 / $1,456.99 / $1,547.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.76 / $946.40 / $1,456.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.57 / $1,456.99 / $1,929.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.45 / $1,501.91 / $1,699.84