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Montana rates for HCPCS 12053

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.25 / $584.25 / $584.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.55 / $314.99 / $594.49
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
$287.82 / $338.62 / $574.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.62 / $338.62 / $338.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.83 / $363.17 / $574.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.86 / $338.62 / $560.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.89 / $409.60 / $689.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.84 / $589.28 / $643.94