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Virginia rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,888.44 / $15,135.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $2,187.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $7,413.10 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,348.96 / $2,344.23
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,445.44 / $12,022.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,318.26 / $2,398.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $1,905.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,884.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,412.54 / $2,290.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $9,549.93
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $9,549.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $11,220.18 / $23,988.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $2,187.76