go back

Tennessee rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $2,691.53 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $691.83 / $1,412.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,606.93 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,380.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,365.16 / $4,365.16
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $5,754.40
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
$562.34 / $776.25 / $1,288.25