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Illinois 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
$1,258.93 / $4,168.69 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $5,495.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,585.78 / $10,232.93 / $48,977.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,162.28 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,090.30 / $4,677.35
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,801.89 / $16,595.87
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,818.38 / $3,090.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,370.32 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,691.53 / $4,677.35