go back

Montana rates for HCPCS 15574

Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.39 / $3,959.90 / $4,760.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.84 / $1,168.84 / $1,168.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.67 / $1,280.98 / $1,511.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.40 / $847.56 / $1,704.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.68 / $1,196.16 / $1,651.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.38 / $1,062.38 / $1,062.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.13 / $1,516.44 / $1,632.04