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Montana rates for HCPCS 21123

Geniop Sliding Agmntj W/Interposal Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.42 / $887.28 / $4,689.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,329.22 / $1,329.22 / $1,329.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.64 / $1,293.20 / $1,329.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.07 / $900.72 / $1,329.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.22 / $1,293.20 / $1,828.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,041.29 / $1,041.29 / $1,041.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.51 / $1,459.27 / $1,610.23