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Montana rates for HCPCS 69631

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,159.00 / $4,077.20 / $7,609.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.71 / $854.44 / $3,520.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,413.88 / $1,413.88 / $1,413.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.54 / $1,413.88 / $1,481.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$688.02 / $1,498.90 / $1,648.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.07 / $1,296.24 / $1,869.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.23 / $1,480.31 / $2,492.87