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Montana rates for HCPCS 21086

Impression and custom preparation; auricular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,819.70 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $2,089.30 / $2,630.27
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,691.53 / $3,090.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,691.53 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,290.87 / $3,388.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,238.72 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,511.89 / $3,090.30