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Montana 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 / $7,634.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,230.44 / $2,230.44 / $2,230.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.28 / $2,230.44 / $2,516.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.76 / $1,520.42 / $2,230.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,359.99 / $2,230.44 / $2,942.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,938.28 / $2,350.67 / $2,639.36