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Nebraska 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
$4,241.22 / $10,431.19 / $21,899.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,008.88 / $2,008.88 / $10,830.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.46 / $3,283.73 / $4,378.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,383.00 / $4,892.75 / $6,613.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,008.88 / $3,515.54 / $8,757.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.09 / $4,158.85 / $6,129.23
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,521.98 / $4,852.51 / $6,829.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,517.00 / $4,426.10 / $6,613.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,210.00 / $7,221.00 / $8,632.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.09 / $4,634.83 / $5,507.51