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Maryland 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
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,290.87 / $7,244.36
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,511.89 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,754.23 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,238.72 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,511.89 / $4,466.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $3,090.30