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New York 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
$1,559.61 / $5,012.00 / $11,161.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,289.38 / $2,363.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,046.00 / $7,264.00 / $12,538.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.09 / $1,370.07 / $2,993.62
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,752.55 / $1,752.55 / $12,319.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.55 / $1,752.55 / $1,752.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.30 / $1,381.30 / $1,381.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.80 / $2,001.00 / $4,636.35
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,600.00 / $3,146.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,343.95 / $1,842.66 / $2,699.28
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,154.09 / $1,154.09 / $1,154.09
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.87 / $1,251.08 / $2,596.41
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $1,381.30
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.89 / $1,833.25 / $4,326.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,264.00 / $5,963.00 / $14,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.07 / $1,555.65 / $3,867.22
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.87 / $1,471.87 / $5,641.02
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.01 / $1,608.35 / $3,111.29