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Montana rates for HCPCS 28750

Arthrodesis, great toe; metatarsophalangeal joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,462.50 / $20,705.20 / $26,445.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.59 / $820.76 / $11,596.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.47 / $1,008.12 / $1,232.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$916.47 / $916.47 / $916.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.41 / $916.47 / $1,368.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.21 / $656.50 / $1,130.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.61 / $1,047.60 / $1,580.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.53 / $1,314.87 / $1,471.36