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Idaho rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,805.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.93 / $2,776.42 / $5,503.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,439.02 / $4,439.02 / $4,451.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.00 / $2,900.36 / $4,907.56
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.08 / $2,254.69 / $6,604.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.19 / $4,065.86 / $4,938.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $3,494.79 / $4,396.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,662.17 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.61 / $2,955.25 / $5,480.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.00 / $5,550.00 / $12,233.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,073.81 / $4,287.18 / $6,248.09