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Michigan rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.39 / $4,933.00 / $6,853.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.85 / $1,077.39 / $1,118.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.56 / $216.56 / $796.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.39 / $1,273.83 / $2,101.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.00 / $1,014.83 / $1,859.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.51 / $4,933.00 / $6,853.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.04 / $949.21 / $1,378.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $583.81 / $953.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.51 / $1,053.94 / $1,461.64