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Montana rates for HCPCS 64865

Suture Facial Nerve Infratemporal W/Wo Graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.27 / $1,482.37 / $5,735.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.58 / $1,713.58 / $1,713.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$951.10 / $1,713.58 / $1,861.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$839.70 / $1,154.58 / $1,713.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.29 / $1,713.58 / $2,280.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.17 / $1,814.81 / $2,002.55