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Montana rates for HCPCS 21261

Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,572.52 / $3,448.10 / $12,969.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,814.15 / $3,814.15 / $3,814.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,832.49 / $3,402.95 / $3,814.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.29 / $2,595.02 / $3,814.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,328.55 / $3,605.91 / $5,038.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,224.52 / $3,982.71 / $4,551.67