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Tennessee rates for HCPCS 21159

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without 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
$2,290.23 / $2,563.16 / $4,167.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,984.00 / $5,467.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,551.46 / $3,477.62 / $5,506.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,716.72 / $3,727.88 / $5,456.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $23,489.68 / $24,144.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,619.68 / $27,619.68 / $27,619.68
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
$2,406.66 / $3,106.33 / $5,667.72