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New York rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.81 / $5,122.00 / $12,075.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.80 / $2,491.75 / $4,628.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,046.00 / $7,264.00 / $12,538.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.68 / $2,827.14 / $6,548.02
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.12 / $3,478.50 / $13,477.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.12 / $962.12 / $3,995.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.52 / $1,144.52 / $1,144.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.13 / $2,734.97 / $8,428.60
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $1,034.00 / $1,726.20
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,735.50 / $3,853.24 / $5,661.67
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,349.07 / $2,349.07 / $2,349.07
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,325.64 / $3,207.79 / $5,419.84
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $1,144.52
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.73 / $3,244.29 / $8,840.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,160.00 / $4,114.00 / $8,926.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,466.52 / $3,520.31 / $9,645.16
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.49 / $803.49 / $3,051.86
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,775.86 / $3,072.43 / $5,419.84