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Montana rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.38 / $3,682.86 / $15,503.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.13 / $1,052.13 / $1,052.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.29 / $1,300.19 / $4,948.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.54 / $1,073.28 / $3,992.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.18 / $2,609.67 / $5,428.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,061.97 / $3,061.97 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,820.98 / $4,772.51 / $5,307.58