go back

Oklahoma 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
$1,411.61 / $4,856.00 / $14,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.03 / $1,411.61 / $1,411.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,334.45 / $14,829.12 / $23,429.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,566.86 / $1,857.02 / $2,284.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,302.66 / $6,302.66 / $6,302.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.26 / $1,756.38 / $2,161.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.27 / $1,879.56 / $8,753.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.93 / $1,546.56 / $14,575.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.00 / $6,627.00 / $10,811.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.58 / $1,449.90 / $2,150.46