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Indiana rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.87 / $2,472.00 / $17,225.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.48 / $784.87 / $1,063.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,719.00 / $11,294.00 / $22,813.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.48 / $1,026.20 / $1,416.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.71 / $990.22 / $1,142.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.71 / $890.51 / $1,142.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,968.60 / $4,968.60 / $5,889.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.99 / $1,064.10 / $1,705.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.76 / $914.05 / $1,653.25