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Massachusetts 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
$1,122.02 / $3,388.44 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,288.25 / $3,235.94
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,168.69 / $13,803.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,819.70 / $14,791.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,862.09 / $3,467.37
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,905.46 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $2,187.76
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,137.96 / $3,467.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,168.69 / $13,803.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,819.70 / $14,791.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,819.70 / $3,467.37