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Montana rates for HCPCS 15841

Graft for facial nerve paralysis; free muscle graft (including obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.04 / $9,373.11 / $9,373.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,801.99 / $2,801.99 / $2,801.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.68 / $2,801.99 / $3,003.10
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,573.32 / $1,909.13 / $3,534.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,700.64 / $2,677.78 / $3,439.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,526.92 / $2,991.06 / $3,268.50