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Montana rates for HCPCS 14301

Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $10,471.29 / $61,659.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$61.66 / $457.09 / $645.65
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
$1,174.90 / $1,380.38 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $1,819.70
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,819.70 / $1,995.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,819.70 / $1,995.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,122.02 / $1,862.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,380.38 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,621.81 / $1,949.84