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California rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,645.00 / $9,674.00 / $21,960.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$700.44 / $827.02 / $4,447.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.00 / $11,216.00 / $21,514.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.33 / $1,177.16 / $2,305.85
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $15,290.89
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$628.50 / $905.14 / $2,054.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,445.00 / $7,280.87 / $13,040.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.10 / $1,059.99 / $2,286.10
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.03 / $1,070.44 / $1,687.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.00 / $1,098.40 / $1,967.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,275.52 / $21,028.65 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,641.99 / $14,641.99 / $14,641.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$879.84 / $1,087.74 / $1,589.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.10 / $1,095.28 / $2,244.42
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,759.83 / $2,759.83 / $2,759.83
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.86 / $1,087.59 / $1,687.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,799.00 / $12,313.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.80 / $872.96 / $1,847.63