go back

New Mexico 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
$2,454.71 / $3,162.28 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $5,495.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,311.31 / $7,244.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $630.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,019.95 / $4,570.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,467.37 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $11,220.18 / $25,703.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,162.28 / $4,365.16