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Georgia 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
$2,187.76 / $5,623.41 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $2,884.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $3,801.89 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,089.30 / $2,951.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,089.30 / $3,388.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,456.54 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,778.28 / $2,951.21