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Nebraska 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
$4,241.22 / $10,431.19 / $21,899.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.48 / $1,253.48 / $7,347.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,199.57 / $2,041.53 / $2,726.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,864.36 / $5,864.36 / $5,864.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,966.00 / $3,059.53 / $4,141.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,253.48 / $2,193.59 / $8,757.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.58 / $2,796.74 / $3,882.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,466.00 / $3,311.22 / $7,127.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,021.63 / $2,741.53 / $4,141.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,210.00 / $7,221.00 / $8,632.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.58 / $2,929.69 / $3,644.09