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Arizona 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
$2,100.00 / $4,521.00 / $9,429.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.98 / $1,166.13 / $2,441.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.84 / $1,459.26 / $1,824.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.83 / $1,459.43 / $2,440.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.30 / $1,584.58 / $7,140.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.40 / $1,359.85 / $14,942.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.40 / $1,275.20 / $2,367.94