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Illinois 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
$1,017.00 / $2,784.00 / $6,661.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.23 / $1,315.89 / $2,537.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,831.58 / $14,107.43 / $30,770.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.08 / $2,140.64 / $2,663.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $7,607.24 / $8,492.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,251.91 / $1,865.81 / $2,815.39
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,468.46 / $2,169.96 / $9,926.03
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,599.18 / $1,649.69 / $1,796.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,052.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,132.00 / $5,951.00 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.25 / $1,741.65 / $3,150.65