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Montana rates for HCPCS D7220

Removal Of Impacted Tooth - Soft Tissue

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.25 / $127.56 / $140.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.00 / $190.00 / $190.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.32 / $216.32 / $216.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.02 / $196.55 / $283.50