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Wyoming 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
Professional
Modifier
Low / Median / High Price
$1,243.33 / $1,249.84 / $1,578.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.39 / $5,006.39 / $5,006.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,378.00 / $2,854.00 / $4,316.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,608.26 / $2,412.39 / $3,443.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.56 / $2,506.11 / $4,044.31