go back

Indiana 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
$1,265.66 / $2,318.00 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.93 / $1,265.66 / $1,708.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.34 / $1,450.10 / $2,001.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.34 / $1,583.86 / $1,827.53
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.34 / $1,340.19 / $1,827.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,239.49 / $5,239.49 / $6,210.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.79 / $1,649.56 / $2,802.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,370.00 / $10,069.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.47 / $1,469.79 / $2,665.99