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Missouri 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
$1,698.24 / $4,265.80 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $3,981.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,698.24 / $2,630.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,862.09 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,995.26 / $6,918.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,995.26 / $16,982.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,715.35 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,698.24 / $2,630.27