go back

Wyoming 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
$1,230.27 / $1,348.96 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,890.45 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,454.71 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,128.61 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,454.71 / $5,248.07