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Montana rates for HCPCS 14021

Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.54 / $755.77 / $1,419.01
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
$950.62 / $1,118.38 / $1,374.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.38 / $1,118.38 / $1,118.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.62 / $1,196.58 / $1,435.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.53 / $850.06 / $1,602.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.00 / $1,169.58 / $1,629.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.64 / $1,453.18 / $1,583.11