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Maine 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
$8,914.93 / $8,914.93 / $8,914.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.03 / $1,438.38 / $1,758.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.69 / $1,813.95 / $2,539.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.74 / $2,055.39 / $2,936.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.40 / $1,915.30 / $2,938.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,914.93 / $8,914.93 / $8,914.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.03 / $1,585.14 / $1,758.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,831.32 / $11,831.32 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.24 / $1,882.83 / $2,681.25