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Idaho 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
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,443.34 / $1,982.44 / $2,964.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,502.28 / $3,502.28 / $3,512.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.25 / $2,145.67 / $2,574.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,364.96 / $2,519.96 / $3,557.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,283.23 / $2,490.80 / $3,382.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,998.21 / $2,513.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,662.17 / $14,534.58 / $18,446.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,346.42 / $2,827.29 / $3,382.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,558.37 / $2,144.48 / $2,989.30