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Maryland 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
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,137.96 / $4,466.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,344.23 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,398.83 / $4,786.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,454.71 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,290.87 / $4,265.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,570.40 / $3,388.44