go back

Tennessee rates for HCPCS 21147

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,630.27 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $3,548.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $6,606.93 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,570.40 / $3,981.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $3,630.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $15,488.17 / $15,488.17
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,135.61 / $15,135.61 / $15,135.61
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
$1,412.54 / $1,905.46 / $3,388.44