go back

New Hampshire 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
$100.00 / $2,080.14 / $4,172.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.55 / $1,209.77 / $1,610.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,215.90 / $2,085.05 / $3,167.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,398.29 / $1,398.29 / $1,398.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.70 / $2,336.98 / $3,651.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.96 / $2,283.65 / $4,296.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.06 / $2,045.66 / $3,459.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.49 / $1,084.04 / $1,379.69