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Alaska rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.00 / $11,709.00 / $20,143.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.16 / $3,348.28 / $11,828.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,712.98 / $2,862.99 / $11,473.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.50 / $3,683.11 / $16,559.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,811.05 / $5,308.30 / $13,712.40
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,701.35 / $4,879.60 / $16,461.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.50 / $3,910.81 / $16,559.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,340.01 / $4,879.60 / $16,647.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,831.32 / $11,831.32 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,795.30 / $11,891.78 / $14,949.66