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Indiana 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
$1,386.00 / $3,344.59 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.05 / $2,060.58 / $2,794.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,310.00 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.84 / $2,775.50 / $3,830.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,979.05 / $2,572.77 / $2,968.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,979.05 / $2,374.86 / $2,968.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,150.31 / $2,785.43 / $4,539.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,393.80 / $10,069.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,801.65 / $2,437.53 / $4,451.14