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West Virginia rates for HCPCS 21179

Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.00 / $1,497.05 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.37 / $1,574.65 / $2,036.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.82 / $1,787.00 / $1,946.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.79 / $1,730.63 / $1,730.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,710.90 / $1,710.90 / $1,710.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.47 / $2,157.14 / $3,913.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,522.00 / $3,522.00 / $3,522.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.41 / $1,832.55 / $2,464.02