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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
$1,100.08 / $1,466.49 / $5,357.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.50 / $1,640.50 / $1,640.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.05 / $1,640.50 / $1,904.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.39 / $1,114.29 / $1,640.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.14 / $1,640.50 / $2,254.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,395.34 / $1,715.12 / $2,500.01