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Tennessee rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,258.00 / $4,069.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.39 / $2,194.98 / $3,586.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,984.00 / $6,552.00 / $9,553.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.61 / $2,737.23 / $4,261.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,106.83 / $2,887.82 / $4,606.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $20,420.48 / $20,864.72
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,626.21 / $24,626.21 / $24,626.21
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
$1,811.60 / $2,444.82 / $4,789.00