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West Virginia 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
$1,294.88 / $1,400.00 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,294.88 / $1,391.53 / $1,978.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.38 / $1,397.39 / $1,667.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.33 / $1,482.19 / $1,482.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,496.15 / $1,496.15 / $1,496.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.88 / $1,878.97 / $3,815.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,522.00 / $3,522.00 / $3,522.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.94 / $1,602.60 / $2,128.28