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Rhode Island 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
$3,438.26 / $3,706.14 / $4,026.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.05 / $1,696.46 / $1,978.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.23 / $1,594.78 / $2,584.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,661.22 / $2,182.76 / $2,839.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,609.00 / $5,979.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.42 / $1,968.27 / $2,931.26