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Montana rates for HCPCS 21215

Graft Bone Mandible

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.12 / $3,374.21 / $6,343.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.47 / $1,242.47 / $6,392.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,242.47 / $1,242.47 / $1,242.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.09 / $1,521.93 / $6,519.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.71 / $1,242.47 / $4,621.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.09 / $3,969.20 / $8,064.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,139.39 / $6,568.78 / $7,741.13