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Utah rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,570.88 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $2,511.89 / $6,309.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $2,089.30 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,513.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $3,162.28 / $6,309.57
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $2,630.27 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $3,467.37 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,445.44 / $4,168.69