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Hawaii 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
$2,570.40 / $6,025.60 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,584.89 / $1,905.46
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,137.96 / $2,344.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,513.56 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $2,238.72
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $1,230.27 / $2,187.76