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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
$1,096.48 / $2,570.40 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $5,623.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,606.93 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,890.45 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,630.78 / $5,495.41
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $23,442.29 / $23,442.29
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27,542.29 / $27,542.29 / $27,542.29
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
$2,290.87 / $3,162.28 / $5,248.07