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Montana rates for HCPCS 22904

Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,205.45 / $10,205.45 / $10,205.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.25 / $2,726.23 / $5,452.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,658.90 / $1,658.90 / $1,990.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,658.90 / $1,658.90 / $1,658.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.01 / $1,658.90 / $1,765.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.36 / $1,834.30 / $1,910.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.82 / $1,522.39 / $2,195.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,439.22 / $1,801.28 / $2,903.57