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Montana rates for HCPCS 21431

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.29 / $1,019.74 / $3,737.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.08 / $1,092.08 / $1,092.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,092.08 / $1,092.08 / $1,092.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.66 / $1,092.08 / $1,319.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.42 / $744.47 / $1,092.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.59 / $1,092.08 / $1,495.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.17 / $1,155.34 / $1,274.86