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Montana rates for HCPCS L8043

Upper facial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,894.62 / $13,508.30 / $13,508.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,600.52 / $4,489.93 / $4,489.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,600.52 / $4,489.93 / $4,489.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,258.80 / $4,276.13 / $4,489.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,369.90 / $3,600.52 / $4,493.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.83 / $2,021.25 / $3,205.69