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Nebraska 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
$1,129.58 / $8,477.27 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,129.58 / $6,035.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.92 / $1,854.41 / $2,472.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,879.65 / $2,767.43 / $3,710.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,129.58 / $1,976.77 / $8,757.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.92 / $2,510.40 / $3,437.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,443.56 / $2,735.78 / $3,786.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.00 / $2,497.92 / $3,710.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,517.92 / $2,564.28 / $3,269.36