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Montana rates for HCPCS 41872

Gingivoplasty Each Quadrant Specify

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.43 / $434.98 / $2,412.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.79 / $484.79 / $484.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.97 / $464.83 / $956.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.91 / $432.48 / $676.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.80 / $681.36 / $1,202.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.29 / $692.28 / $961.29