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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
$16,218.10 / $16,218.10 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,445.44 / $3,801.89
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
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,995.26 / $2,344.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,398.83 / $2,630.27
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,398.83 / $2,630.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $2,884.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,905.46 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,290.87 / $2,630.27