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Alaska rates for HCPCS 21256

Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,558.54 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.57 / $6,035.41 / $6,035.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,039.81 / $4,110.16 / $5,304.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.64 / $6,035.41 / $8,449.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,039.75 / $3,647.70 / $7,405.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,473.75 / $6,116.60 / $7,448.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.64 / $6,035.41 / $8,449.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.74 / $6,058.50 / $7,891.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,284.00 / $5,635.61 / $7,233.86