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West Virginia rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.80 / $1,400.00 / $3,500.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.80 / $1,895.61 / $4,887.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.45 / $713.77 / $853.02
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.24 / $758.24 / $1,347.01
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
$704.43 / $2,416.69 / $6,232.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,450.00 / $2,450.00 / $2,450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.36 / $2,918.56 / $4,525.46