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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
$1,148.15 / $2,818.38 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $4,786.30
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
$2,344.23 / $3,311.31 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,019.95 / $4,677.35
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $19,952.62 / $19,952.62
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,498.45 / $19,498.45 / $19,498.45
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
$1,862.09 / $2,570.40 / $4,365.16