go back

Missouri 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
$2,070.00 / $5,389.00 / $9,823.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.43 / $2,229.53 / $4,063.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,126.75 / $2,653.78 / $4,095.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.06 / $2,966.89 / $4,838.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,802.86 / $2,992.47 / $6,060.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,203.46 / $3,044.50 / $19,652.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,469.00 / $3,892.00 / $8,004.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,091.42 / $2,813.39 / $4,746.24