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Montana 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
$16,197.12 / $16,197.12 / $16,197.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.08 / $1,496.36 / $3,747.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,243.06 / $2,243.06 / $2,243.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,243.06 / $2,243.06 / $2,243.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.44 / $2,243.06 / $2,482.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,108.92 / $1,524.77 / $2,243.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.61 / $2,243.06 / $3,010.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,955.34 / $2,374.52 / $2,620.16