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Pennsylvania 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
$1,278.00 / $4,250.00 / $10,398.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.21 / $843.72 / $1,219.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.72 / $865.18 / $865.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.02 / $943.02 / $943.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.09 / $1,046.68 / $1,741.43
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.66 / $1,300.54 / $1,692.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.00 / $5,350.00 / $11,083.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.52 / $911.47 / $4,689.82
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.70 / $919.70 / $1,828.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.02 / $943.02 / $943.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.53 / $1,061.81 / $1,792.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.51 / $826.51 / $842.69
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.33 / $826.51 / $876.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.00 / $2,715.00 / $4,815.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.18 / $1,046.78 / $1,647.17