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Tennessee rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,500.00 / $4,069.00 / $10,746.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.53 / $874.82 / $1,361.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,013.00 / $6,138.00 / $9,272.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.16 / $1,137.30 / $1,787.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.47 / $1,220.86 / $1,817.64
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,254.80 / $16,547.20 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,243.52 / $13,243.52 / $13,243.52
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
$757.09 / $977.18 / $1,785.17