go back

Maine 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 / $2,511.89 / $5,888.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,235.94 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,090.30 / $4,897.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,951.21 / $5,370.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,019.95 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,818.38 / $4,786.30