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West Virginia 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
$1,212.41 / $1,400.00 / $1,881.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.00 / $1,289.07 / $1,794.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.57 / $1,457.35 / $1,587.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.29 / $1,411.38 / $1,411.38
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
$1,191.83 / $1,652.79 / $3,322.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.04 / $1,322.78 / $1,895.23