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Alaska rates for HCPCS 21193

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,617.34 / $9,813.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $3,617.34 / $6,135.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,102.24 / $4,188.80 / $5,295.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.56 / $6,135.12 / $8,589.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,993.68 / $3,592.41 / $7,292.94
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,597.50 / $6,153.00 / $7,364.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.56 / $6,135.12 / $8,589.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.36 / $6,062.10 / $8,100.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,351.04 / $5,864.32 / $7,372.29