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Montana rates for HCPCS 21195

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,399.88 / $1,955.97 / $7,347.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.05 / $2,100.05 / $2,100.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.13 / $2,100.05 / $2,252.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,038.10 / $1,427.40 / $2,100.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,284.61 / $2,100.05 / $2,779.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,653.74 / $1,653.74 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,858.37 / $2,214.23 / $2,530.55