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Connecticut 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
$3,522.00 / $7,360.00 / $10,492.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.05 / $1,475.71 / $3,703.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,920.00 / $11,936.00 / $15,915.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.01 / $2,610.44 / $3,606.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.00 / $7,993.34 / $7,993.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,873.81 / $2,560.94 / $3,667.43
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,346.67 / $2,466.00 / $2,518.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,211.15 / $2,012.55 / $2,520.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,644.00 / $8,468.00 / $13,943.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.20 / $2,304.05 / $4,263.14