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Montana rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.57 / $975.88 / $3,619.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.68 / $859.68 / $1,017.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$859.68 / $859.68 / $859.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.16 / $859.68 / $1,239.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.45 / $608.48 / $983.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.41 / $934.20 / $1,347.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.97 / $1,131.03 / $1,648.63