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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
$624.82 / $656.51 / $3,402.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.88 / $985.88 / $985.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.13 / $985.88 / $1,131.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.35 / $681.11 / $985.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.12 / $985.88 / $1,359.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.32 / $1,070.08 / $1,180.79