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Montana rates for HCPCS 21347

Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,348.96 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,548.82 / $1,698.24
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $1,995.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $1,995.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,548.82 / $2,344.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,412.54 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,698.24 / $1,949.84