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Wisconsin 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 $10,233 · 10th–90th $4,898–$16,9820%5%10%10th90th$10,233Professionalmedian $3,236 · 10th–90th $1,995–$9,5500%20%10th90th$3,236$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
$2,137.96 / $4,466.84 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,187.76 / $5,495.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $4,466.84 / $10,964.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $6,606.93 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $8,912.51 / $10,000.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $4,897.79 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,128.61 / $6,760.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $4,677.35 / $15,135.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $4,168.69 / $19,498.45
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $5,248.07 / $9,120.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $4,677.35 / $6,760.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,120.11 / $19,952.62 / $19,952.62
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $10,715.19 / $19,498.45
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,079.46 / $7,079.46 / $7,079.46
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,918.31 / $12,022.64 / $13,803.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $15,848.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,311.31 / $8,912.51