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California 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
$1,992.00 / $8,050.00 / $18,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,386.66 / $7,634.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $9,447.00 / $18,544.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,624.58 / $2,046.58 / $4,016.79
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.40 / $100.00 / $7,296.75
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.49 / $1,559.60 / $3,535.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $5,729.24 / $10,261.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,382.70 / $1,798.04 / $3,954.03
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,116.90 / $1,659.71 / $2,240.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,339.05 / $1,856.08 / $3,318.92
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $7,846.38 / $16,547.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,154.97 / $17,154.97 / $17,154.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.01 / $1,843.75 / $2,806.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.21 / $1,845.82 / $3,829.13
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,737.10 / $4,737.10 / $4,737.10
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.86 / $1,675.35 / $2,112.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,830.00 / $12,341.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.49 / $1,465.62 / $3,232.28