go back

Nebraska 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
$4,241.22 / $9,544.15 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,331.13 / $7,094.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.89 / $2,170.73 / $2,895.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,376.03 / $4,376.03 / $4,376.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,087.00 / $3,248.07 / $4,384.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.13 / $2,329.48 / $8,632.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,792.62 / $2,868.34 / $4,039.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,578.00 / $3,523.06 / $5,542.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,251.28 / $2,942.14 / $4,384.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,792.62 / $2,964.72 / $3,737.38