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Montana rates for HCPCS L8041

Midfacial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,454.71 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,951.21 / $3,548.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,311.31 / $6,456.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,311.31 / $6,456.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,884.03 / $5,011.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,754.23 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $2,137.96 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $2,454.71