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North Carolina 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
$1,406.94 / $5,577.21 / $10,561.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.96 / $1,484.27 / $3,747.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,602.01 / $2,757.28 / $4,657.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.96 / $2,040.63 / $3,648.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.94 / $1,810.94 / $2,911.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,810.94 / $1,863.00 / $1,863.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,852.80 / $3,960.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.88 / $1,774.58 / $3,869.71
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $13,073.36 / $13,073.36
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,789.51 / $15,789.51 / $15,789.51