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Montana rates for HCPCS 21182

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,818.38 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,691.53 / $3,311.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,630.78 / $3,890.45
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,630.78 / $3,890.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,951.21 / $4,365.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,884.03 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,388.44 / $4,073.80