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North Carolina 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
$1,862.09 / $8,709.64 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $3,467.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $8,317.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,698.24 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,819.70 / $3,388.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $3,162.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,691.53
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,290.87 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $11,748.98 / $18,620.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,884.03
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $22,387.21 / $22,387.21
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40