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North Carolina 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
$1,206.02 / $7,944.78 / $11,299.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,246.43 / $2,437.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.53 / $2,427.92 / $5,400.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.06 / $1,758.34 / $3,094.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.02 / $1,531.18 / $2,521.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.00 / $1,478.00 / $1,586.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $1,594.50 / $3,498.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.77 / $1,484.98 / $3,046.55
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $11,953.99 / $13,960.05
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,942.49 / $14,942.49 / $14,942.49