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Montana rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,511.89 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,630.27 / $3,467.37
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,715.35 / $4,365.16
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,715.35 / $4,365.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,630.27 / $3,981.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,884.03 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,311.31 / $3,981.07