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Maryland rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.71 / $2,459.51 / $3,192.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.04 / $852.08 / $937.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.21 / $990.00 / $3,490.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.74 / $2,199.11 / $5,896.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,625.79 / $3,410.49 / $5,046.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.00 / $648.66 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,335.42 / $3,335.42 / $5,648.49
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.67 / $3,040.36 / $3,751.13