go back

Montana rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.65 / $1,212.74 / $4,570.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,333.43 / $1,333.43 / $1,333.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.99 / $1,333.43 / $1,509.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.19 / $909.14 / $1,333.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.69 / $1,333.43 / $1,765.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,159.95 / $1,412.31 / $1,579.51