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Michigan 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
$1,580.07 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,312.29 / $1,640.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,968.13 / $5,831.13 / $7,900.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.23 / $1,579.43 / $3,088.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.82 / $1,417.02 / $2,635.85
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.36 / $1,580.07 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.36 / $1,347.36 / $2,019.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.33 / $851.06 / $1,432.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.15 / $1,425.57 / $1,977.11