go back

Montana rates for HCPCS 17004

Destruction Premalignant Lesion 15/>

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.07 / $373.07 / $373.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.65 / $160.84 / $311.85
Aetna
Facility/Professional
Professional
Modifier
22
Low / Median / High Price
$799.01 / $799.01 / $799.01
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
$131.84 / $155.11 / $265.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.11 / $155.11 / $155.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.24 / $167.07 / $265.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.23 / $155.11 / $292.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.16 / $188.80 / $318.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.96 / $264.32 / $292.50