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New Mexico 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
$1,000.00 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,466.35 / $2,305.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.86 / $2,052.85 / $2,584.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,184.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,340.45 / $1,768.44 / $3,861.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.76 / $2,127.92 / $3,489.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.79 / $2,103.25 / $3,211.34