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Montana rates for HCPCS 14041

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,283.30 / $2,283.30 / $2,283.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.14 / $879.78 / $1,498.98
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
$1,200.93 / $1,200.93 / $1,462.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.93 / $1,200.93 / $1,200.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.79 / $1,294.36 / $1,553.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.55 / $904.09 / $1,730.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.44 / $1,243.35 / $1,733.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.93 / $1,555.83 / $1,671.32