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Montana rates for HCPCS 12004

Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.05 / $506.21 / $833.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $115.76 / $447.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.68 / $115.68 / $210.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.68 / $115.68 / $115.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.68 / $145.66 / $211.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.18 / $117.45 / $286.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.53 / $140.51 / $249.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.10 / $225.09 / $313.30