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North Dakota 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
$2,213.96 / $2,213.96 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,178.83 / $2,247.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,367.93 / $4,804.95 / $5,634.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,652.67 / $5,299.69 / $7,059.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,213.96 / $2,981.48 / $3,763.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,323.81 / $4,061.53 / $5,728.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,667.00 / $8,667.00 / $8,667.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,323.81 / $4,061.53 / $5,112.38