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Maryland 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
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,258.93 / $3,235.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,548.82 / $2,754.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,288.25 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $2,570.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,412.54 / $1,778.28