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Montana rates for HCPCS 21143

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.33 / $2,021.66 / $7,610.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,210.46 / $2,210.46 / $2,210.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,239.22 / $2,210.46 / $2,447.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.20 / $1,505.90 / $2,210.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.44 / $2,210.46 / $2,911.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,929.82 / $2,340.42 / $2,627.84