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Montana rates for HCPCS 42815

Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx

Insurance Carrier
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
$856.53 / $856.53 / $856.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.13 / $748.04 / $1,045.52