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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
$1,848.66 / $5,063.00 / $7,421.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.66 / $1,469.42 / $3,115.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.26 / $4,412.76 / $8,702.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,305.30 / $1,873.88 / $3,400.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,068.78 / $2,068.78 / $2,068.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,496.15 / $1,496.15 / $5,378.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.41 / $2,143.06 / $3,416.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.83 / $2,085.17 / $3,235.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,845.00 / $7,357.00 / $11,889.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.93 / $1,855.07 / $3,088.43