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Montana rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,584.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $912.01 / $1,122.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,096.48 / $1,202.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,096.48 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $954.99 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $891.25 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,071.52 / $1,230.27