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Washington rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Facilitymedian $4,898 · 10th–90th $2,399–$19,9530%10%10th90th$4,898Professionalmedian $2,818 · 10th–90th $1,660–$5,2480%10%10th90th$2,818$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $8,912.51 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,398.83 / $4,786.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,168.69 / $5,754.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,388.44 / $6,025.60
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,890.45 / $7,079.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,801.89 / $5,754.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $134.90
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,981.07 / $4,073.80
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,951.21
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,265.80 / $5,623.41
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,168.69 / $5,754.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,818.38 / $5,495.41
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,344.23 / $4,265.80