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Tennessee 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
$1,256.00 / $3,329.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,186.61 / $1,370.33 / $2,146.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,430.00 / $5,467.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,307.56 / $1,779.13 / $2,797.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.53 / $1,859.33 / $2,903.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $22,175.10 / $22,175.10
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,575.95 / $14,575.95 / $14,575.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,604.00 / $5,898.00 / $11,506.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.93 / $1,553.06 / $2,979.18