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Indiana rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $4,897.79 / $17,378.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,089.30 / $3,890.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $18,197.01 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,000.00 / $1,548.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $691.83 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,888.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,479.11 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $6,025.60 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $2,041.74 / $4,168.69