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Massachusetts 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
$2,570.40 / $3,715.35 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $5,128.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,248.07 / $15,135.61
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,019.95 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,019.95 / $5,754.40
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $3,235.94 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,818.38 / $3,890.45
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,981.07 / $6,309.57
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,248.07 / $15,135.61
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,019.95 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,951.21 / $6,456.54