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Maine 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
$1,778.28 / $2,398.83 / $4,897.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,090.30 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,884.03 / $4,570.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,090.30 / $5,888.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,691.53 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,570.40 / $4,570.88