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Pennsylvania rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

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
$1,513.56 / $1,737.80 / $4,365.16
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,995.26 / $3,311.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,398.83 / $3,090.30
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,235.94
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
$1,548.82 / $2,238.72 / $5,011.87
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $3,467.37
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,238.72 / $3,235.94
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,905.46 / $1,905.46
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,659.59 / $1,905.46
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
$1,445.44 / $1,995.26 / $3,235.94