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Florida 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
$1,229.38 / $5,182.00 / $11,624.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,396.58 / $1,835.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $2,907.91 / $3,461.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.60 / $1,798.04 / $2,846.91
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,979.00 / $12,804.00 / $23,031.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.45 / $1,277.08 / $1,539.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.29 / $1,048.41 / $1,799.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,581.00 / $10,309.00 / $15,888.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.83 / $1,486.79 / $2,669.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.28 / $1,092.28 / $1,336.53