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Maine rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.66 / $883.65 / $3,641.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.80 / $896.23 / $1,285.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.73 / $2,698.21 / $5,555.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.65 / $2,555.06 / $5,041.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.93 / $920.56 / $3,641.43
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
$2,460.19 / $3,907.36 / $5,289.41