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Montana rates for HCPCS 21400

Closed treatment of fracture of orbit, except blowout; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.94 / $177.47 / $852.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.36 / $272.36 / $272.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.86 / $245.12 / $323.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.94 / $181.04 / $272.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.04 / $272.36 / $406.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $319.00 / $365.71