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Arizona 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
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,258.93 / $3,548.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,370.32 / $7,943.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,737.80 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,659.59 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $14,791.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $5,888.44 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,258.93 / $2,238.72