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Montana rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $208.93 / $426.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $234.42 / $575.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $354.81 / $407.38
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $354.81 / $407.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $245.47 / $446.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $302.00 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $407.38