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Montana rates for HCPCS 40702

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 2 Stgs

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.21 / $5,287.32 / $5,287.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,578.45 / $1,578.45 / $1,578.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.20 / $1,578.45 / $1,699.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$978.88 / $1,076.77 / $2,119.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.30 / $1,578.45 / $1,934.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,360.15 / $1,684.89 / $1,841.18