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Montana rates for HCPCS 21440

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.68 / $581.87 / $1,265.25
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
$958.53 / $958.53 / $958.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.33 / $789.61 / $1,079.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.00 / $581.01 / $958.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.95 / $951.89 / $1,370.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.97 / $1,004.08 / $1,183.39