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Montana rates for HCPCS 21155

Rcnstj Midface Lefort Iii W/Lefort I

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,276.78 / $3,021.34 / $11,334.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,401.93 / $3,401.93 / $3,401.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,799.74 / $3,401.93 / $3,947.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,671.87 / $2,298.82 / $3,420.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,065.87 / $3,401.93 / $4,470.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,962.08 / $3,607.59 / $4,128.29