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Montana rates for HCPCS 21184

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 greater than 80 sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,625.73 / $3,453.80 / $13,090.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,886.19 / $3,886.19 / $3,886.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,002.14 / $3,886.19 / $4,036.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,923.06 / $2,644.21 / $3,886.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,368.02 / $3,886.19 / $5,124.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,269.04 / $4,070.87 / $4,583.63