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Vermont 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
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,818.38 / $6,760.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $7,762.47 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,019.95 / $5,011.87
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,019.95 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,162.28 / $9,120.11