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Montana rates for HCPCS 13133

Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.51 / $144.03 / $268.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $265.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.60 / $195.60 / $195.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.26 / $219.41 / $294.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.82 / $162.50 / $288.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.04 / $225.25 / $316.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.45 / $289.57 / $315.64