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Idaho 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
$4,365.16 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,818.38 / $5,128.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $8,128.31 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,168.69 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,090.30 / $3,890.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,467.37 / $5,623.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,630.78 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $13,182.57 / $18,620.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $4,265.80 / $4,677.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,511.89 / $10,964.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $3,311.31 / $4,570.88