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Montana rates for HCPCS 21193

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,204.51 / $6,623.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,929.69 / $1,929.69 / $1,929.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.54 / $1,929.69 / $1,993.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.88 / $1,315.71 / $1,929.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.31 / $1,929.69 / $2,541.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,681.66 / $2,039.46 / $2,320.56