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Montana rates for HCPCS 21100

Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.70 / $947.14 / $3,594.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.66 / $563.66 / $563.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.18 / $688.79 / $1,211.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.12 / $520.79 / $951.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.16 / $742.10 / $1,301.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.12 / $1,117.46 / $1,626.90