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Texas rates for HCPCS 21390

Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$928.78 / $3,866.00 / $13,004.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,171.46 / $7,615.33 / $14,939.63
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.13 / $6,087.90 / $6,087.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.02 / $903.02 / $903.02
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,000.00 / $16,547.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.06 / $942.90 / $1,534.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.25 / $953.23 / $1,571.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $6,000.00 / $13,134.00