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Montana rates for HCPCS 15842

Graft for facial nerve paralysis; free muscle flap by microsurgical technique

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,467.37 / $8,912.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $4,265.80 / $4,570.88
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,677.35 / $5,248.07
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,677.35 / $5,248.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,818.38 / $4,365.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $3,630.78 / $5,248.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $4,365.16 / $5,011.87