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Maine 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
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,424.31 / $1,831.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.93 / $1,920.39 / $2,700.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.07 / $2,185.98 / $3,105.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,763.39 / $2,040.24 / $3,129.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,424.31 / $1,831.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.86 / $1,956.12 / $2,843.47