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California rates for HCPCS 21196

Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,992.00 / $8,011.00 / $20,135.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.08 / $1,406.94 / $5,545.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,447.00 / $18,544.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,592.30 / $2,106.17 / $4,082.98
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.40 / $100.00 / $7,296.75
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.24 / $1,626.22 / $3,662.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,367.59 / $1,816.90 / $4,021.72
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,042.44 / $1,577.52 / $2,098.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.79 / $1,866.57 / $3,458.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $13,073.36 / $13,377.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,789.51 / $15,789.51 / $15,789.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.36 / $1,866.57 / $2,846.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,407.32 / $1,901.70 / $3,850.41
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,683.22 / $4,683.22 / $4,683.22
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.17 / $1,563.66 / $1,971.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,830.00 / $12,341.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.26 / $1,511.39 / $3,310.37