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Minnesota 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
$1,443.80 / $1,443.80 / $6,575.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.91 / $1,443.80 / $2,281.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,365.24 / $11,518.20 / $22,604.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,459.42 / $3,944.21 / $4,976.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,478.44 / $4,935.41 / $11,872.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.13 / $4,154.70 / $6,170.36
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.22 / $4,512.14 / $9,348.65
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.32 / $3,714.58 / $5,658.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,475.71 / $2,494.61 / $5,331.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,601.49 / $2,898.94 / $5,825.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $7,872.00 / $11,531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,532.99 / $2,918.63 / $5,441.75