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Montana rates for HCPCS 13121

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $897.60 / $1,127.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.34 / $367.36 / $777.47
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
$403.81 / $403.81 / $670.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.81 / $403.81 / $403.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.24 / $445.23 / $700.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.04 / $400.54 / $737.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.24 / $487.68 / $803.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.29 / $722.17 / $775.77