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Montana rates for HCPCS 42215

Palatoplasty Cleft Palate Major Revj

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.10 / $704.93 / $3,787.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.07 / $1,112.07 / $1,112.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.92 / $994.22 / $1,785.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.81 / $1,003.17 / $1,337.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.79 / $1,124.23 / $1,873.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.02 / $1,177.61 / $1,491.22