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Alaska rates for HCPCS 21123

Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,451.60 / $13,413.92 / $20,143.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.44 / $4,157.99 / $4,157.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,152.13 / $2,885.86 / $3,660.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.44 / $4,157.99 / $5,821.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,049.15 / $2,458.98 / $4,991.97
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,167.50 / $4,327.52 / $5,290.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.44 / $4,157.99 / $5,821.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.35 / $4,184.39 / $5,819.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,308.67 / $3,482.89 / $5,079.10