go back

Delaware 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
$5,816.00 / $5,816.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.49 / $1,423.13 / $1,424.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,200.76 / $3,200.76 / $3,200.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.45 / $1,490.16 / $2,648.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,530.00 / $2,530.00 / $2,530.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.33 / $1,487.20 / $3,317.42