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Tennessee rates for HCPCS 21175

Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,966.75 / $3,940.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.05 / $2,163.60 / $3,470.49
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
$2,111.66 / $2,919.62 / $4,640.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,268.08 / $3,086.13 / $4,655.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $20,049.20 / $20,496.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,301.40 / $19,652.56 / $19,652.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,604.00 / $5,898.00 / $11,506.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,975.24 / $2,487.61 / $4,697.33