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Washington, DC 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
$1,614.00 / $4,100.00 / $7,007.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,285.08 / $2,285.08 / $5,788.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,586.60 / $2,617.98 / $12,839.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,169.02 / $3,286.44 / $6,104.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,410.03 / $5,007.41 / $5,007.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $11,831.32 / $28,056.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.70 / $3,141.14 / $6,062.62