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Montana rates for HCPCS 21435

Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.12 / $1,968.09 / $7,416.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,219.92 / $2,219.92 / $2,219.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.85 / $2,114.98 / $2,219.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.51 / $1,417.07 / $2,219.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.41 / $2,114.98 / $2,913.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,916.18 / $2,229.75 / $2,583.98