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Oklahoma 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
$1,296.28 / $3,742.00 / $18,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.66 / $1,296.28 / $1,309.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $900.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.83 / $1,587.45 / $1,941.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.32 / $1,698.39 / $8,753.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.76 / $1,354.23 / $14,641.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.80 / $1,298.50 / $1,830.89