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Idaho 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
$4,415.00 / $4,500.00 / $8,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,394.09 / $1,900.84 / $2,791.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,693.43 / $4,693.43 / $4,706.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,537.41 / $2,049.88 / $2,485.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,282.49 / $2,392.53 / $3,377.35
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.42 / $2,338.27 / $3,180.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,872.71 / $2,355.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,262.69 / $2,662.00 / $3,180.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,462.45 / $2,040.58 / $2,925.95