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Alaska rates for HCPCS 21194

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,183.02 / $9,774.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,323.96 / $7,094.54 / $7,094.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,585.21 / $4,829.47 / $6,124.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.15 / $7,094.54 / $9,932.36
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,459.45 / $4,151.34 / $8,427.66
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,298.75 / $7,093.28 / $8,648.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.15 / $7,094.54 / $9,932.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,153.36 / $7,010.80 / $9,277.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,863.58 / $6,761.27 / $8,499.87