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Kentucky 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
$1,862.09 / $2,818.38 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,238.72 / $5,888.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,715.19 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,089.30 / $3,162.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,754.23 / $3,548.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,754.23 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,715.35 / $19,054.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,677.35 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,630.27 / $4,365.16