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Montana rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.38 / $1,590.28 / $2,489.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.75 / $2,021.65 / $2,914.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,429.26 / $2,192.59 / $3,141.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,212.39 / $2,698.75 / $3,089.27