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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,818.38 / $11,748.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,090.30 / $4,786.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $4,570.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $4,265.80 / $6,165.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $4,073.80 / $5,370.32
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,388.44 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,344.23 / $3,548.13