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Montana rates for HCPCS 21147

Rcnstj Midface Lefort I 3/> Piece W/Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.81 / $1,683.03 / $9,141.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,666.86 / $2,666.86 / $2,666.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,666.86 / $2,666.86 / $2,666.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.66 / $2,666.86 / $3,026.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,321.06 / $1,721.37 / $2,666.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,626.56 / $2,666.86 / $3,544.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,322.73 / $2,816.94 / $3,162.88