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Maine rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,380.38 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,548.82 / $2,454.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,621.81 / $3,090.30
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,412.54 / $3,235.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $2,511.89