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Montana rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,477.33 / $12,061.00 / $12,061.00
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
$3,214.74 / $4,008.87 / $4,008.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,214.74 / $4,008.87 / $4,008.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,016.78 / $3,817.97 / $4,008.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,008.84 / $3,214.74 / $4,011.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.10 / $1,804.68 / $2,862.21