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Montana rates for HCPCS 30920

Ligation arteries; internal maxillary artery, transantral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,380.38 / $1,380.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,513.56 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,513.56 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,258.93 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $870.96 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $2,089.30