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Tennessee rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,402.22 / $3,050.06 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.43 / $1,535.97 / $2,482.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,430.00 / $5,486.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,530.48 / $2,075.21 / $3,335.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.87 / $2,136.55 / $3,311.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,181.68 / $14,476.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,677.74 / $13,677.74 / $13,677.74
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
$1,378.28 / $1,735.02 / $3,252.26