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California rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $10,232.93 / $23,988.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $4,786.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $13,489.63 / $22,387.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,412.54 / $2,754.23
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $5,754.40 / $16,982.44
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,412.54 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $8,317.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $2,630.27
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,202.26 / $2,187.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $2,454.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $33,884.42 / $33,884.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $12,022.64 / $12,022.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,698.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $2,344.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,380.38 / $2,691.53
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,981.07
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,288.25 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $12,302.69 / $25,703.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $2,238.72