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Tennessee rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,570.40 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,348.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,168.69 / $5,888.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,047.13 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $851.14 / $1,380.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $33,884.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,495.41 / $5,495.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $3,630.78 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $758.58 / $1,318.26