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Montana rates for HCPCS 15733

Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,621.81 / $1,778.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $2,187.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,778.28 / $2,187.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,096.48 / $1,621.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,348.96 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $1,949.84