go back

Montana rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $891.25 / $1,737.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,174.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $1,348.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,096.48 / $1,348.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $891.25 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $1,258.93