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Montana rates for HCPCS 69604

Revision mastoidectomy; resulting in tympanoplasty

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.03 / $2,914.02 / $5,828.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.06 / $1,764.06 / $1,764.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,211.16 / $1,764.06 / $1,863.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.80 / $1,920.10 / $2,089.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.55 / $1,617.99 / $2,333.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.55 / $1,862.63 / $3,108.92