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Utah 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
$1,982.44 / $4,387.00 / $8,344.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.39 / $1,424.31 / $7,634.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,450.65 / $2,010.94 / $2,983.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.95 / $839.02 / $1,328.43
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,238.37 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,845.91 / $2,390.21 / $3,778.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.25 / $1,488.00 / $2,391.92