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Tennessee rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.74 / $3,329.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.60 / $659.86 / $1,059.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,830.00 / $5,500.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.13 / $881.58 / $1,385.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.15 / $908.72 / $1,343.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $4,362.54 / $4,393.14
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,358.53 / $5,563.75 / $5,747.35
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
$570.62 / $737.99 / $1,355.49