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Montana rates for HCPCS 12021

Tx Superficial Wound Dehiscence W/Packing

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.64 / $135.88 / $190.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.95 / $223.47 / $281.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.47 / $223.47 / $223.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.20 / $231.64 / $281.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.53 / $171.22 / $320.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.20 / $232.72 / $334.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.10 / $284.20 / $310.56