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Michigan rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,290.87 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,513.56 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,862.09 / $4,265.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $6,918.31 / $8,709.64
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $3,019.95 / $4,265.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,174.90 / $4,265.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,011.87 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,862.09 / $3,890.45