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Montana rates for HCPCS 64821

Sympathectomy Radial Artery

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.15 / $945.74 / $3,643.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,116.80 / $1,116.80 / $1,116.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.07 / $1,116.80 / $1,148.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.72 / $761.37 / $1,116.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.85 / $1,104.82 / $1,436.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.35 / $1,126.32 / $1,283.20