go back

Montana rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,258.93 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,348.96 / $1,862.09
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,905.46 / $2,187.76
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,905.46 / $2,187.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,479.11 / $2,041.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,479.11 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $2,238.72