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Montana rates for HCPCS 21245

Rcnstj Mndbl/Maxl Subpriosteal Implant Partial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.84 / $1,181.76 / $4,979.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.96 / $1,486.96 / $1,486.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.60 / $1,340.96 / $1,922.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.70 / $1,034.84 / $1,587.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.52 / $1,610.88 / $2,377.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.58 / $1,901.90 / $2,191.67