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Montana rates for HCPCS 21390

Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22,489.20 / $22,489.20 / $22,489.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,269.28 / $1,269.28 / $1,269.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$623.59 / $836.10 / $1,269.28