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Missouri 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
$1,760.00 / $5,389.00 / $9,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.50 / $1,242.02 / $1,856.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,224.50 / $1,493.16 / $2,336.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.35 / $1,671.49 / $2,791.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.65 / $1,738.83 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,231.65 / $1,754.06 / $14,942.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,162.16 / $1,614.11 / $2,598.56