go back

Maine 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
$1,122.02 / $1,412.54 / $3,235.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,819.70 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,737.80 / $2,754.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,659.59 / $3,162.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,698.24 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,584.89 / $2,691.53