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Montana rates for HCPCS 12011

Simple Repair F/E/E/N/L/M 2.5cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.20 / $336.58 / $692.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.25 / $107.81 / $407.00
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
$87.28 / $87.28 / $177.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.28 / $87.28 / $87.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.28 / $114.64 / $180.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.63 / $100.70 / $246.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.58 / $114.54 / $212.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.80 / $185.85 / $261.76