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Montana rates for HCPCS 21076

Impression&Preparation Surg Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.83 / $1,240.50 / $4,802.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.85 / $1,107.85 / $1,364.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.85 / $1,107.85 / $1,107.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.37 / $1,159.78 / $1,656.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$558.17 / $863.66 / $1,390.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.84 / $1,228.01 / $1,765.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.24 / $1,527.51 / $1,796.12