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Arizona 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
$2,089.30 / $4,786.30 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,862.09 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,584.89 / $2,754.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,819.70 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,621.81 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $6,025.60 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,380.38 / $2,454.71