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Montana rates for HCPCS 14040

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,080.16 / $3,080.16 / $3,080.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.87 / $710.29 / $2,289.50
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
$984.82 / $984.82 / $1,205.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.82 / $984.82 / $984.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.57 / $1,053.42 / $1,255.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.39 / $743.83 / $1,412.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.27 / $1,024.35 / $1,428.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.45 / $1,272.04 / $1,366.47