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Wyoming 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
$1,423.15 / $1,443.34 / $1,831.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.39 / $5,006.39 / $5,006.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,709.00 / $3,251.00 / $4,918.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,011.57 / $2,886.69 / $3,951.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,608.21 / $2,872.50 / $4,835.99