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Montana rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,907.19 / $2,537.65 / $9,501.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,849.84 / $2,849.84 / $2,849.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.09 / $2,849.84 / $3,450.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,399.90 / $1,924.87 / $2,945.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.37 / $2,849.84 / $3,902.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,481.96 / $3,072.73 / $3,378.56