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Washington, DC 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
$1,469.19 / $4,100.00 / $6,945.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.19 / $1,469.19 / $1,469.19
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,594.95 / $1,662.50 / $6,846.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.21 / $2,039.76 / $3,905.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,552.46 / $3,218.43 / $3,218.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,089.75 / $1,868.38 / $3,896.65