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Montana rates for HCPCS 21145

Rcnstj Midface Lefort I 1 Piece W/Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,297.89 / $1,537.04 / $3,800.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,427.62 / $2,427.62 / $2,427.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.52 / $2,427.62 / $2,749.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.94 / $1,629.79 / $2,427.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,480.34 / $2,427.62 / $3,203.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,111.71 / $2,561.01 / $2,965.39