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Tennessee rates for HCPCS 21194

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.05 / $2,977.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.58 / $1,429.74 / $2,281.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,984.00 / $5,467.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.91 / $1,901.57 / $2,996.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.43 / $1,998.52 / $3,038.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $16,547.20 / $16,547.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,154.97 / $17,154.97 / $17,154.97
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
$1,265.08 / $1,578.02 / $3,117.76