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Connecticut 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
$3,943.00 / $7,629.00 / $13,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.66 / $1,406.22 / $3,554.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,920.00 / $11,936.00 / $15,915.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.69 / $2,540.42 / $3,510.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.00 / $10,711.96 / $10,711.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.66 / $2,399.81 / $3,558.62
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,330.14 / $4,873.00 / $4,974.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.48 / $1,947.32 / $2,438.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,644.00 / $8,553.00 / $13,943.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.14 / $2,293.40 / $3,888.86