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New York 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
$2,195.96 / $5,067.00 / $11,880.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,287.90 / $3,912.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,046.00 / $7,264.00 / $12,538.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,814.11 / $2,371.39 / $5,483.27
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,124.27 / $3,124.27 / $12,319.50
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,124.27 / $3,124.27 / $3,124.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,486.26 / $2,486.26 / $2,486.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,169.02 / $3,473.16 / $8,239.56
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $3,246.00 / $5,789.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,388.92 / $3,365.75 / $4,966.26
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,051.46 / $2,051.46 / $2,051.46
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.34 / $2,621.79 / $4,624.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $2,486.26
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,278.27 / $3,352.64 / $8,027.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,705.00 / $5,547.00 / $12,457.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,989.80 / $2,763.61 / $7,003.90
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.79 / $2,621.79 / $9,831.29
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,782.82 / $2,858.91 / $5,542.05