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Montana rates for HCPCS 21267

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.53 / $2,297.31 / $8,591.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,520.16 / $2,520.16 / $2,520.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.77 / $2,520.16 / $2,632.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,246.42 / $1,713.83 / $2,520.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,539.54 / $2,520.16 / $3,331.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,203.82 / $2,672.72 / $3,384.48