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Tennessee rates for HCPCS 21431

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.98 / $753.44 / $1,110.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,430.00 / $5,467.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.77 / $960.47 / $1,525.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.44 / $973.46 / $1,456.02
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $4,791.35 / $4,890.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,069.52 / $5,175.28 / $5,820.08
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
$611.07 / $793.89 / $1,469.25