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Michigan rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Facilitymedian $5,754 · 10th–90th $4,266–$7,9430%20%10th90th$5,754Professionalmedian $1,413 · 10th–90th $1,202–$2,2390%20%10th90th$1,413$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,897.79 / $4,897.79 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,380.38 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,698.24 / $2,290.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,621.81 / $2,818.38
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,698.24 / $2,290.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $7,762.47 / $14,791.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,584.89 / $2,137.96