go back

Montana rates for HCPCS 21172

Rcnstj Superior-Lateral Orbital Rim & Lower Fhd

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,652.75 / $2,320.30 / $10,514.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,383.52 / $3,383.52 / $3,383.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.05 / $2,962.38 / $3,383.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,658.59 / $2,073.23 / $3,299.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,904.30 / $3,129.79 / $4,417.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,612.13 / $2,612.13 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,175.40 / $3,314.29 / $3,819.27