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Montana rates for HCPCS 21100

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

Facilitymedian $813 · 10th–90th $617–$1,2300%10%20%10th90th$813Professionalmedian $676 · 10th–90th $363–$1,5850%10%10th90th$676$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $660.69 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $707.95 / $1,202.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $1,047.13 / $1,202.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,047.13 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $691.83 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $707.95 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $831.76 / $1,380.38