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North Dakota 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
$1,394.09 / $1,394.09 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.09 / $1,365.07 / $1,394.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.80 / $2,895.14 / $3,406.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,658.76 / $3,314.00 / $4,414.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,394.09 / $1,623.80 / $2,369.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.98 / $2,459.58 / $3,633.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,667.00 / $8,667.00 / $8,667.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.98 / $2,459.58 / $3,139.36