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Wisconsin rates for HCPCS 21195

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

Facilitymedian $10,233 · 10th–90th $3,981–$16,9820%5%10%10th90th$10,233Professionalmedian $1,995 · 10th–90th $1,230–$6,1660%10%20%10th90th$1,995$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,754.23 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,348.96 / $3,388.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,754.23 / $7,413.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,073.80 / $6,918.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $5,495.41 / $6,165.95
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,818.38 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,235.94 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $3,090.30 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $2,454.71 / $14,454.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,691.53 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $3,235.94 / $5,888.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,884.03 / $4,365.16
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,943.28 / $15,135.61 / $22,387.21
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $6,760.83 / $14,454.40
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $4,466.84
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $7,762.47 / $8,511.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $15,848.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,041.74 / $5,623.41