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Tennessee 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
$1,821.00 / $2,683.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.13 / $1,209.77 / $1,976.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,171.00 / $6,434.00 / $9,283.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,190.98 / $1,620.53 / $2,563.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.15 / $1,672.53 / $2,598.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $13,960.05 / $13,960.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,641.99 / $14,641.99 / $14,641.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.73 / $1,365.05 / $2,666.00