go back

Tennessee rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,821.00 / $3,940.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,910.90 / $2,224.39 / $3,472.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,830.00 / $5,467.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,084.59 / $2,894.46 / $4,583.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,265.19 / $3,115.48 / $4,546.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $19,610.56 / $20,170.48
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,628.38 / $22,628.38 / $22,628.38
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
$1,908.05 / $2,614.11 / $4,738.50