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Kentucky 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 / $2,818.38 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,089.30 / $3,715.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,715.19 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,570.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,630.27 / $3,388.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,630.27 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $3,467.37 / $10,471.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $4,677.35 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,238.72 / $4,073.80