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North Carolina 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
$1,396.58 / $2,252.84 / $10,561.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,281.71 / $1,424.31 / $2,719.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,625.15 / $2,704.56 / $3,750.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $5,006.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,537.52 / $1,997.50 / $3,630.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.58 / $1,757.77 / $2,832.65
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.77 / $1,853.00 / $1,853.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $1,842.60 / $3,687.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.77 / $1,711.00 / $3,511.76
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,442.95 / $16,547.20
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,154.97 / $17,154.97 / $17,154.97