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Nebraska rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,452.42 / $10,977.72 / $24,068.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.25 / $2,452.42 / $4,159.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.12 / $1,498.00 / $4,881.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,546.46 / $5,546.46 / $5,546.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.61 / $4,732.00 / $7,505.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.13 / $2,452.42 / $6,631.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,468.86 / $5,795.23 / $9,616.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,696.01 / $5,544.36 / $7,395.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,482.53 / $4,840.75 / $7,456.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,711.00 / $5,356.00 / $7,772.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,468.86 / $5,336.70 / $7,471.38