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Michigan rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,412.54 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $2,089.30
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,230.27 / $1,778.28
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,202.26 / $1,621.81