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Utah rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $6,025.60 / $10,232.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $1,778.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $2,187.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,548.82 / $2,041.74
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,412.54