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Montana rates for HCPCS D7111

Extraction Coronal Remnants-Primary Tooth

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.30 / $54.30 / $54.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.73 / $72.73 / $72.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.35 / $81.53 / $117.60