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Idaho rates for HCPCS 21387

Open treatment of orbital floor blowout fracture; combined approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,415.00 / $4,500.00 / $8,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.02 / $1,062.51 / $1,561.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.34 / $1,148.00 / $1,369.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.97 / $1,375.67 / $1,873.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.75 / $1,351.37 / $1,787.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,061.34 / $1,335.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.14 / $1,534.28 / $1,787.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.67 / $1,171.56 / $1,627.00