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Montana rates for HCPCS 21160

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

Facilitymedian $4,786 · 10th–90th $3,631–$5,1290%50%10th90th$4,786Professionalmedian $3,890 · 10th–90th $2,692–$6,9180%10%20%10th90th$3,890$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,801.89 / $7,585.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,630.78 / $4,466.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,786.30 / $5,128.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $4,786.30 / $5,128.61
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $4,073.80 / $5,754.40
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $3,801.89 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,677.35 / $6,025.60