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Montana rates for HCPCS 15845

Graft for facial nerve paralysis; regional muscle transfer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,288.25 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,698.24 / $1,819.70
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,862.09 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,862.09 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $1,698.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,380.38 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $1,862.09