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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
$1,483.69 / $1,686.00 / $4,348.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,535.41 / $2,535.41 / $2,535.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.35 / $2,535.41 / $2,863.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,256.45 / $1,727.62 / $2,535.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.04 / $2,535.41 / $3,343.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,278.17 / $2,719.62 / $3,384.48