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Idaho rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,805.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.95 / $1,187.84 / $1,722.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,450.79 / $4,450.79 / $4,463.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.37 / $1,242.69 / $1,475.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.87 / $1,466.40 / $2,083.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,364.19 / $1,488.20 / $1,969.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,169.89 / $1,471.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,437.27 / $1,690.91 / $1,969.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.28 / $1,268.81 / $1,805.61