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Alaska rates for HCPCS 21395

Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.58 / $13,413.92 / $20,143.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.32 / $4,927.93 / $4,927.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,487.85 / $3,358.38 / $4,318.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.39 / $4,927.93 / $6,899.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,459.15 / $2,950.98 / $5,990.77
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,633.75 / $5,044.76 / $6,046.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.39 / $4,927.93 / $6,899.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,498.45 / $4,981.35 / $6,393.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,669.42 / $4,701.72 / $5,910.74