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Indiana 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
$1,778.28 / $4,897.79 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $3,715.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,238.72 / $3,630.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,995.26 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,818.38 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,398.83 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,041.74 / $3,548.13