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Texas 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
$1,220.90 / $3,682.00 / $12,941.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.47 / $1,479.34 / $2,293.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,452.08 / $2,447.41 / $10,002.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.50 / $1,218.95 / $2,200.09
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $1,266.84 / $1,279.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,599.88 / $1,599.88 / $1,599.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.63 / $1,912.53 / $3,017.62
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $13,073.36
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,789.51 / $15,789.51 / $15,789.51
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,374.59 / $1,751.93 / $3,091.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,734.58 / $2,081.48 / $2,581.05
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.70 / $1,565.70 / $1,565.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.15 / $1,775.78 / $3,216.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.21 / $1,983.37 / $3,044.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.33 / $1,551.39 / $2,463.90
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.33 / $1,347.64 / $1,878.01