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Montana rates for HCPCS 21047

Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.32 / $1,309.78 / $6,759.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,904.45 / $1,904.45 / $1,904.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.28 / $1,904.45 / $2,226.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.09 / $1,300.86 / $1,904.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.69 / $1,904.45 / $2,613.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.27 / $2,131.48 / $2,531.09