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West Virginia 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
$1,400.00 / $2,197.01 / $3,374.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,176.44 / $2,338.21 / $2,909.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,349.01 / $2,613.17 / $2,847.11
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.22 / $2,530.76 / $2,530.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,513.88 / $2,513.88 / $2,513.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.13 / $2,794.26 / $5,334.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,610.24 / $2,495.87 / $3,374.35