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Alaska rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,839.33 / $9,813.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,965.73 / $9,903.68 / $9,903.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,984.22 / $6,620.74 / $8,963.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.73 / $9,903.68 / $13,865.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,203.75 / $6,244.50 / $12,676.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,573.75 / $9,927.50 / $12,870.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.39 / $9,903.68 / $13,865.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,021.13 / $9,394.77 / $13,228.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,831.32 / $11,831.32 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,296.60 / $9,269.04 / $11,652.52