go back

Florida 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
$1,115.00 / $4,022.00 / $12,173.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.93 / $1,316.07 / $1,761.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $3,896.92 / $4,639.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.50 / $1,691.81 / $2,721.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,979.00 / $12,804.00 / $23,031.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.79 / $1,199.57 / $1,439.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.75 / $944.80 / $1,664.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,771.00 / $10,309.00 / $15,888.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.89 / $1,409.71 / $2,588.46
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.38 / $1,025.38 / $1,267.61