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Indiana rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.49 / $2,472.00 / $17,225.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.64 / $802.49 / $1,083.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,719.00 / $11,294.00 / $22,813.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.87 / $1,076.40 / $1,485.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.96 / $1,010.05 / $1,165.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.96 / $858.54 / $1,165.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,909.74 / $3,909.74 / $4,634.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.96 / $1,063.03 / $1,840.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.55 / $947.80 / $1,722.40