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Pennsylvania 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 / $6,918.31 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $2,238.72
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $2,187.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,089.30 / $2,630.27
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,513.56 / $2,290.87
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,668.36 / $44,668.36 / $44,668.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $5,495.41 / $10,964.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,380.38 / $3,162.28
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $2,454.71
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,479.11 / $2,511.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $933.25 / $1,318.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $933.25 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,202.26 / $2,041.74