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Montana rates for HCPCS 15100

Split Agrft T/A/L 1st 100 Cm/&/1% Bdy Inft/Chld

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,559.33 / $2,559.33 / $2,559.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.40 / $785.28 / $1,481.21
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
$1,131.00 / $1,131.00 / $1,373.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,131.00 / $1,131.00 / $1,131.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.35 / $1,196.58 / $1,422.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$633.74 / $844.82 / $1,594.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.76 / $1,187.46 / $1,639.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.77 / $1,444.31 / $1,574.36