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Montana rates for HCPCS 21433

Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,838.74 / $2,421.66 / $9,159.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,726.80 / $2,726.80 / $2,726.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,400.78 / $2,726.80 / $2,913.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,351.41 / $1,858.19 / $2,726.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.88 / $2,726.80 / $3,591.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,373.96 / $2,879.07 / $3,232.64