go back

Vermont rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,659.59 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,905.46 / $3,162.28
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,905.46 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,949.84 / $5,754.40