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West Virginia 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
$1,380.07 / $1,400.00 / $2,300.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.07 / $1,469.19 / $2,224.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.32 / $1,495.18 / $1,787.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.30 / $1,589.04 / $1,589.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.46 / $1,596.46 / $1,596.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.85 / $1,986.29 / $4,273.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,083.49 / $1,584.84 / $2,239.21