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Utah 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 $3,162–$11,2200%10%20%10th90th$6,026Professionalmedian $3,162 · 10th–90th $1,995–$11,7490%10%20%10th90th$3,162$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
$3,162.28 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $3,467.37 / $13,489.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $4,677.35
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $4,570.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $11,481.54 / $17,782.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,630.78 / $6,165.95
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $4,073.80 / $5,370.32
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,162.28 / $4,786.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,290.87 / $3,715.35