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Montana rates for HCPCS 40654

Repair lip, full thickness; over one-half vertical height, or complex

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $645.65 / $1,479.11
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
$575.44 / $676.08 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $707.95 / $954.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $977.24 / $1,096.48
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $977.24 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $616.60 / $1,023.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $676.08 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $794.33 / $1,047.13