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Tennessee rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.11 / $3,152.05 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.71 / $1,653.55 / $2,530.94
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
$1,558.70 / $2,144.58 / $3,397.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,654.89 / $2,259.78 / $3,422.72
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,426.72 / $14,754.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,441.12 / $15,441.12 / $15,441.12
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
$1,344.55 / $1,862.79 / $3,301.34