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Tennessee rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,148.15 / $2,089.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $6,760.83 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,548.82 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $2,344.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $23,988.33 / $33,884.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,022.64 / $12,022.64 / $12,022.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $5,754.40 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,230.27 / $2,089.30