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Montana rates for HCPCS 64809

Sympathectomy Thoracolumbar

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.54 / $1,414.26 / $5,464.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,754.07 / $1,754.07 / $1,754.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.36 / $1,754.07 / $1,874.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$864.48 / $1,080.59 / $1,568.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.62 / $1,750.24 / $2,272.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.20 / $1,722.60 / $1,985.06