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Idaho rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,495.41 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $2,187.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,918.31 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,905.46 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,445.44 / $2,089.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,659.59 / $2,818.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $2,570.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $18,620.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $2,630.27
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,737.80 / $9,332.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,479.11 / $2,187.76