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Alaska rates for HCPCS 21196

Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,180.45 / $9,774.00 / $14,772.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.96 / $1,515.38 / $7,090.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,494.11 / $4,748.18 / $6,168.58
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.41 / $7,090.19 / $9,926.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,469.15 / $4,162.97 / $8,451.29
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,272.50 / $6,959.80 / $8,532.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.41 / $7,090.19 / $9,926.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.91 / $6,959.80 / $9,369.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.64 / $6,510.43 / $8,356.79