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Montana rates for HCPCS 15576

Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.48 / $692.41 / $1,272.88
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
$1,021.10 / $1,021.10 / $1,235.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,021.10 / $1,021.10 / $1,021.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.04 / $1,118.02 / $1,331.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.24 / $764.18 / $1,503.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.65 / $1,063.26 / $1,470.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.34 / $1,342.25 / $1,441.89