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Arkansas 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
$1,233.00 / $1,821.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.43 / $1,690.27 / $1,900.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,430.62 / $5,430.62 / $6,516.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.67 / $1,780.84 / $1,885.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,337.37 / $4,337.37 / $4,337.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.73 / $2,038.40 / $2,492.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $3,709.00 / $7,779.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.93 / $1,601.08 / $2,555.50