go back

Wyoming 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
$2,190.62 / $2,232.52 / $2,807.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.39 / $5,006.39 / $5,006.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,215.00 / $5,058.00 / $7,651.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,061.62 / $4,465.04 / $6,085.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $11,831.32 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,366.14 / $4,484.95 / $7,950.80