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Ohio 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
$1,925.00 / $5,747.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.00 / $1,396.58 / $2,742.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,003.00 / $4,426.00 / $19,117.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.44 / $1,486.13 / $2,344.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.64 / $1,358.88 / $1,978.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.15 / $1,465.46 / $1,865.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.85 / $1,875.74 / $2,711.01
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.46 / $1,596.46 / $1,596.46
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.86 / $1,924.48 / $2,711.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.74 / $992.27 / $1,676.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,206.00 / $6,231.00 / $10,075.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.01 / $1,783.09 / $2,783.89