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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
$130.06 / $205.63 / $358.72
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
$214.53 / $214.53 / $344.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.53 / $214.53 / $214.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.50 / $235.07 / $480.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.51 / $218.84 / $392.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.60 / $320.14 / $554.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.39 / $358.40 / $447.52