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Alaska rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,420.66 / $13,413.92 / $20,143.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.90 / $4,105.53 / $4,105.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.39 / $2,781.61 / $3,619.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.05 / $4,105.53 / $5,747.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,066.94 / $2,480.34 / $5,035.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,022.50 / $4,196.80 / $5,074.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.05 / $4,105.53 / $5,747.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.93 / $4,148.00 / $5,304.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,204.98 / $3,894.28 / $4,895.66