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West Virginia 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
$1,192.00 / $1,400.00 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,204.51 / $1,762.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.15 / $1,293.93 / $1,546.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.36 / $1,375.00 / $1,375.00
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
$1,178.27 / $1,771.46 / $3,407.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.81 / $1,462.11 / $2,002.28