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Tennessee rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,741.62 / $3,788.29 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.62 / $2,052.06 / $3,128.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,830.00 / $5,467.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,877.58 / $2,617.92 / $4,128.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,056.90 / $2,805.79 / $4,094.77
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $17,685.75 / $18,191.12
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,633.29 / $19,633.29 / $19,633.29
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
$1,745.21 / $2,338.16 / $4,201.21