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Washington 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 $5,248 · 10th–90th $2,818–$20,8930%10%10th90th$5,248Professionalmedian $3,162 · 10th–90th $1,995–$6,0260%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
$4,168.69 / $10,232.93 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,818.38 / $6,165.95
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,265.80 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $758.58 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,630.78 / $6,606.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $4,365.16 / $7,762.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $4,073.80 / $6,025.60
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $141.25
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,265.80 / $4,466.84
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $2,951.21 / $3,019.95
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,365.16 / $5,754.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,265.80 / $6,025.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,235.94 / $5,754.40
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,238.72 / $3,981.07