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Michigan 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
$4,897.79 / $4,897.79 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,584.89 / $3,890.45
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,513.56 / $2,089.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,584.89 / $2,089.30