go back

Tennessee rates for HCPCS 21193

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,583.63 / $3,850.80 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.68 / $1,220.57 / $2,058.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,367.00 / $5,486.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.32 / $1,629.37 / $2,556.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.08 / $1,720.28 / $2,636.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $13,960.05 / $13,960.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,942.49 / $14,942.49 / $14,942.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.18 / $1,472.44 / $2,704.57