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Montana rates for HCPCS 21179

Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,137.96 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,949.84 / $2,398.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,570.40 / $2,818.38
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,570.40 / $2,818.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,187.76 / $3,162.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,041.74 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,454.71 / $2,884.03