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Pennsylvania rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $4,063.00 / $10,398.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.16 / $2,385.57 / $3,270.33
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.29 / $2,540.67 / $2,540.67
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
$680.74 / $2,309.71 / $4,750.21
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,980.81 / $3,971.97 / $5,148.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.00 / $5,350.00 / $11,083.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.38 / $2,409.00 / $5,363.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.20 / $859.20 / $7,387.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.52 / $1,144.52 / $1,144.52
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.32 / $2,346.58 / $4,803.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.51 / $683.95 / $2,519.73
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.15 / $2,214.71 / $2,741.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.00 / $2,715.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.82 / $3,335.82 / $5,406.01