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Montana rates for HCPCS 21348

Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,659.59 / $1,778.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,089.30
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,089.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,698.24 / $2,398.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,479.11 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,819.70 / $2,041.74