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Indiana 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
$1,150.67 / $1,386.00 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.66 / $1,151.51 / $1,553.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.24 / $1,566.50 / $2,161.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,142.35 / $1,567.94 / $2,351.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.96 / $1,343.95 / $2,015.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.11 / $1,515.91 / $2,505.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.06 / $1,354.82 / $2,345.19