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Missouri 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
$1,760.00 / $5,389.00 / $9,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.66 / $1,351.58 / $2,149.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.00 / $1,601.88 / $2,479.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.65 / $1,796.60 / $3,054.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.34 / $1,851.66 / $4,763.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.50 / $1,909.78 / $14,575.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $3,892.00 / $8,004.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,284.28 / $1,734.34 / $2,879.86