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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
$1,148.15 / $1,380.38 / $3,548.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,445.44 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $645.65 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,659.59 / $3,090.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,513.56 / $2,754.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,513.56 / $1,949.84