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North Carolina 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
$1,208.17 / $1,615.00 / $7,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,209.77 / $2,332.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,838.61 / $3,838.61 / $5,484.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,320.28 / $1,843.54 / $3,290.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.32 / $1,711.40 / $3,027.43
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.17 / $1,469.83 / $2,380.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.83 / $1,509.00 / $1,597.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,618.50 / $3,190.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.94 / $1,428.35 / $3,034.46
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $11,953.99 / $13,960.05
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,641.99 / $14,641.99 / $14,641.99