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Rhode Island 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
$2,993.72 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.20 / $1,806.70 / $2,224.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.07 / $1,696.99 / $2,640.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.71 / $2,256.07 / $2,957.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $7,228.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.28 / $1,803.56 / $2,995.35