go back

Utah 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
$1,905.46 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,819.70 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,398.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,570.40 / $3,388.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,454.71 / $3,311.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,137.96 / $3,090.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,412.54 / $2,187.76