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Michigan 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
$1,806.70 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,436.35 / $1,876.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,951.91 / $8,159.50 / $11,054.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.16 / $1,384.74 / $2,407.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,049.81 / $1,641.48 / $3,116.76
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.47 / $1,806.70 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.93 / $1,553.71 / $2,290.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.00 / $982.04 / $1,632.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,413.92 / $1,681.82 / $2,426.69