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Indiana rates for HCPCS 21387

Open treatment of orbital floor blowout fracture; combined approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$712.55 / $1,854.00 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.86 / $712.55 / $974.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.86 / $860.60 / $1,187.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.11 / $967.79 / $1,451.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.28 / $864.10 / $1,244.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.21 / $946.43 / $1,577.89
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
$630.20 / $825.11 / $1,460.75