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Montana rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,344.23 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,187.76 / $2,691.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,884.03 / $3,162.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,884.03 / $3,162.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,454.71 / $3,388.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,290.87 / $3,467.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,691.53 / $3,235.94