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Texas 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
$969.00 / $3,511.00 / $12,040.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.88 / $1,256.44 / $1,970.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,252.01 / $7,663.84 / $16,006.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,146.95 / $1,638.11 / $2,167.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $1,087.89 / $1,105.86
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
$1,205.58 / $1,648.73 / $2,473.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $13,960.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,641.99 / $14,641.99 / $14,641.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.96 / $1,452.42 / $2,532.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.88 / $1,823.85 / $2,261.57
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.80 / $1,500.80 / $1,500.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.96 / $1,477.80 / $2,729.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,246.55 / $1,699.10 / $2,565.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.48 / $1,321.92 / $2,094.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.73 / $1,179.30 / $1,637.71