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Montana rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $4,265.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,137.96 / $2,630.27
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,951.21
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,951.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $3,467.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $2,137.96 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,630.27 / $3,090.30