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West Virginia 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
$1,400.00 / $2,181.82 / $3,352.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,285.08 / $3,149.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,323.86 / $2,596.62 / $2,829.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.06 / $2,514.71 / $2,514.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,486.26 / $2,486.26 / $2,486.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,118.04 / $3,097.35 / $7,002.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,522.00 / $3,522.00 / $3,522.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,655.83 / $2,531.89 / $3,559.46