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Pennsylvania 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)

Facilitymedian $6,026 · 10th–90th $1,445–$10,4710%10%20%10th90th$6,026Professionalmedian $2,239 · 10th–90th $1,995–$5,0120%50%10th90th$2,239$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $6,025.60 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,238.72 / $5,128.61
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,388.44 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,630.27 / $4,466.84
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,090.30 / $3,981.07
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,570.40 / $3,548.13
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $4,786.30 / $8,709.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,238.72 / $5,128.61
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,388.44 / $5,370.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,454.71
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,187.76 / $2,290.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,511.89 / $4,466.84