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Montana rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,346.87 / $11,674.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,950.19 / $2,950.19 / $3,470.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,470.81 / $3,470.81 / $3,470.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.64 / $3,470.81 / $3,888.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,715.53 / $2,358.85 / $3,470.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,118.60 / $3,470.81 / $4,584.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,731.57 / $2,731.57 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,119.17 / $3,670.23 / $4,093.31