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Tennessee rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,235.01 / $2,977.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,356.91 / $2,190.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,695.00 / $5,467.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.21 / $1,856.42 / $2,880.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.62 / $1,901.58 / $2,908.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $12,527.60 / $12,790.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,111.43 / $13,111.43 / $13,111.43
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
$1,230.34 / $1,566.90 / $2,941.03