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Washington, DC 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
$1,391.53 / $4,100.00 / $7,007.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.53 / $1,391.53 / $1,391.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,571.93 / $1,575.44 / $9,276.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.94 / $1,950.78 / $3,710.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,463.26 / $3,043.11 / $3,043.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,099.00 / $11,831.32 / $28,056.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.48 / $1,795.20 / $3,684.39