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Montana rates for HCPCS 21263

Periorbital Osteotomies W/Bone Grafts W/Forehead

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,379.48 / $3,193.84 / $12,003.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,529.17 / $3,529.17 / $3,529.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,552.59 / $3,145.13 / $3,529.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.56 / $2,233.09 / $3,494.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,154.83 / $3,338.49 / $4,662.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,973.65 / $3,617.33 / $4,168.49