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Alaska rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,904.65 / $9,813.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.93 / $6,622.41 / $6,622.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,399.04 / $4,575.80 / $5,776.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,249.32 / $6,622.41 / $9,271.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,247.60 / $3,897.12 / $7,911.52
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,020.00 / $6,788.25 / $8,266.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,249.32 / $6,622.41 / $9,271.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.64 / $6,608.25 / $9,092.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,831.32 / $11,831.32 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,660.64 / $6,406.12 / $8,053.41