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Minnesota 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
$1,365.07 / $1,365.07 / $6,781.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,331.40 / $1,365.07 / $2,146.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,158.03 / $11,518.20 / $21,868.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,308.79 / $3,724.41 / $4,859.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,284.82 / $4,660.68 / $11,211.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,456.73 / $3,913.53 / $5,812.19
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,986.20 / $4,260.97 / $8,828.28
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,224.25 / $3,504.09 / $5,330.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.33 / $2,349.59 / $5,331.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.79 / $2,639.91 / $5,602.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $6,787.00 / $11,165.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.79 / $2,639.91 / $5,348.82