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Michigan 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
$1,883.00 / $4,933.00 / $26,791.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.47 / $1,515.38 / $2,531.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,984.44 / $8,197.68 / $11,106.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.70 / $1,335.21 / $2,456.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.29 / $1,685.36 / $3,040.68
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,496.93 / $4,933.00 / $26,791.45
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.61 / $1,631.13 / $2,790.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.00 / $960.89 / $1,622.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.29 / $1,771.23 / $2,437.52