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Montana rates for HCPCS 21122

Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,949.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $954.99 / $1,174.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,288.25 / $1,621.81
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,288.25 / $1,621.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,000.00 / $1,445.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,023.29 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,230.27 / $1,445.44