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Maine 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
$8,646.91 / $8,646.91 / $9,508.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.08 / $1,488.76 / $1,811.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,497.70 / $1,938.21 / $2,712.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,441.40 / $2,173.94 / $3,136.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.34 / $2,045.97 / $3,138.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,646.91 / $8,646.91 / $9,508.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.08 / $1,493.80 / $1,811.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.84 / $2,019.09 / $2,862.94