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Maryland rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,208.09 / $1,370.33 / $1,603.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,571.93 / $1,575.44 / $2,016.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $3,691.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.89 / $1,741.83 / $3,171.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.06 / $1,778.99 / $2,341.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.00 / $1,301.58 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.54 / $1,528.18 / $2,828.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,267.61 / $1,585.92 / $1,971.92