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Arizona 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
$1,965.00 / $4,521.00 / $9,112.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.92 / $829.42 / $1,988.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,310.70 / $4,934.39 / $8,070.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.36 / $999.27 / $1,249.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.61 / $1,016.88 / $1,715.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.84 / $1,092.02 / $3,978.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.20 / $933.24 / $8,519.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,149.00 / $3,533.00 / $5,546.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.05 / $880.60 / $1,664.89