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Montana rates for HCPCS 21256

Reconstruction Orbit W/Osteotomies & Bone Grafts

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,309.91 / $6,550.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,958.08 / $1,958.08 / $1,958.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.08 / $1,958.08 / $1,997.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.89 / $1,317.78 / $1,958.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.98 / $1,958.08 / $2,564.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.05 / $2,014.87 / $2,284.91