go back

Pennsylvania 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
$1,261.45 / $4,048.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.81 / $1,220.57 / $1,762.82
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.83 / $1,270.02 / $1,270.02
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
$1,154.56 / $1,501.09 / $2,463.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.62 / $1,893.69 / $2,465.90
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,170.90 / $18,170.90 / $18,170.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $4,993.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,343.37 / $3,746.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.20 / $1,332.20 / $2,551.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.30 / $1,381.30 / $1,381.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.38 / $1,558.65 / $2,610.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.76 / $1,202.76 / $1,274.58
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.08 / $1,202.76 / $1,274.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.10 / $1,504.37 / $2,388.96