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Montana rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,197.12 / $16,197.12 / $16,197.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.19 / $1,399.83 / $1,953.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,145.26 / $2,145.26 / $2,145.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,144.73 / $2,144.73 / $2,144.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,193.17 / $2,144.73 / $2,426.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.63 / $1,461.12 / $2,144.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,305.97 / $2,144.73 / $2,851.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.03 / $2,253.19 / $2,529.91