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Montana rates for HCPCS 21436

Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,155.48 / $2,845.09 / $10,751.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.85 / $3,206.85 / $3,206.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,746.00 / $3,206.85 / $3,419.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,589.06 / $2,184.94 / $3,206.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.15 / $3,206.85 / $4,213.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,527.94 / $2,527.94 / $2,527.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,783.34 / $3,370.08 / $3,790.08