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Hawaii 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
$2,528.00 / $2,747.00 / $6,084.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,141.51 / $5,910.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,143.23 / $2,738.03 / $3,285.63
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,906.10 / $3,265.09 / $3,796.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,409.46 / $2,628.50 / $3,066.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $2,912.00 / $2,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,234.23 / $2,738.03 / $3,576.98
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.27 / $1,985.92 / $3,565.53