go back

Montana rates for HCPCS 21146

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,089.30 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,344.23 / $2,818.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,818.38 / $2,951.21
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,818.38 / $2,951.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,398.83 / $3,388.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,290.87 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,691.53 / $3,090.30