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Tennessee 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
$1,517.00 / $3,410.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.94 / $1,422.05 / $2,324.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,830.00 / $5,467.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.23 / $1,927.09 / $2,982.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.22 / $2,032.98 / $3,068.77
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.43 / $1,583.61 / $3,030.17