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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
$1,153.13 / $1,516.18 / $5,664.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,731.99 / $1,731.99 / $1,731.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$924.19 / $1,731.99 / $2,021.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.00 / $1,171.50 / $1,731.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.84 / $1,731.99 / $2,364.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.17 / $1,833.12 / $2,242.60