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Arizona rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $4,521.00 / $9,112.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.84 / $991.91 / $1,962.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,310.70 / $4,934.39 / $8,070.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.07 / $1,402.65 / $1,619.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.97 / $1,257.16 / $2,173.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.58 / $1,271.75 / $6,612.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.79 / $1,338.56 / $11,980.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.31 / $1,192.32 / $2,353.80