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Montana rates for HCPCS 21141

Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $7,244.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,862.09 / $2,290.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,344.23 / $2,570.40
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,344.23 / $2,570.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,949.84 / $2,818.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,862.09 / $2,754.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,238.72 / $2,570.40