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Montana rates for HCPCS 21049

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.72 / $1,284.75 / $6,328.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.70 / $1,809.80 / $2,037.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.85 / $1,809.80 / $2,475.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.66 / $2,002.42 / $2,220.16