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Tennessee rates for HCPCS 21100

Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.00 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.06 / $562.41 / $997.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,309.00 / $5,486.00 / $9,272.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.91 / $710.18 / $1,273.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.77 / $729.57 / $1,325.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,512.80 / $2,523.90 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,663.28 / $4,505.20 / $5,233.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.28 / $780.19 / $1,517.84