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Montana rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $1,445.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $1,621.81
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $1,621.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $891.25 / $1,479.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,122.02 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,288.25 / $1,548.82