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Montana rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.27 / $841.29 / $1,142.22
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
$1,259.29 / $1,259.29 / $1,259.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.09 / $1,259.29 / $1,326.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.99 / $855.24 / $1,259.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.67 / $1,259.29 / $1,661.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.03 / $1,256.27 / $1,396.88