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Pennsylvania 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
$1,445.44 / $6,165.95 / $9,549.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $4,786.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,344.23 / $4,168.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,311.31 / $4,365.16
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,630.27 / $3,548.13
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141,253.75 / $141,253.75 / $141,253.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $5,248.07 / $9,549.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,691.53 / $6,025.60
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $4,265.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $4,265.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,187.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,187.76 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,290.87 / $3,981.07