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Indiana 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
$1,352.45 / $7,395.02 / $36,753.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.94 / $1,352.45 / $1,825.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,215.09 / $1,592.30 / $2,197.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.86 / $1,692.43 / $1,952.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.86 / $1,562.24 / $1,952.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.23 / $1,772.83 / $3,036.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.17 / $1,556.53 / $2,826.74