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Indiana rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $4,897.79 / $17,378.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,949.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $18,197.01 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,698.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $954.99 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,258.93 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,096.48 / $1,949.84