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Texas rates for HCPCS 21387

Open treatment of orbital floor blowout fracture; combined approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$916.00 / $3,682.00 / $12,826.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.55 / $774.81 / $1,299.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,165.24 / $7,421.31 / $14,745.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.83 / $770.69 / $1,246.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $683.66 / $691.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$863.37 / $863.37 / $863.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.97 / $1,015.52 / $1,547.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,000.00 / $13,960.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,296.79 / $8,296.79 / $8,296.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.79 / $934.46 / $1,571.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.45 / $1,126.14 / $1,396.41
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.50 / $866.50 / $866.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.79 / $937.40 / $1,724.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.38 / $1,062.27 / $1,599.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.40 / $823.18 / $1,303.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.75 / $726.79 / $1,011.77