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Vermont 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
Professional
Modifier
Low / Median / High Price
$1,424.31 / $1,718.55 / $1,718.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,499.72 / $2,506.48 / $3,261.46
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.29 / $2,129.64 / $3,261.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.40 / $2,048.46 / $5,955.04