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Arizona 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
$1,965.00 / $4,474.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.09 / $1,350.45 / $2,827.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,475.47 / $1,686.25 / $2,107.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.80 / $1,670.61 / $2,881.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,354.71 / $1,826.42 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.20 / $1,556.63 / $17,154.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,613.00 / $6,455.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.72 / $1,452.81 / $2,729.29