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Indiana rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,910.52 / $2,082.85 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,864.05 / $2,082.85 / $2,811.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,310.00 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,657.86 / $2,516.69 / $3,473.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,013.70 / $2,617.81 / $3,020.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,013.70 / $2,225.14 / $3,020.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,810.07 / $2,571.42 / $4,383.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,780.21 / $2,373.61 / $4,201.29