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Arizona 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
$1,965.00 / $4,521.00 / $9,112.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.51 / $973.42 / $5,331.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,763.75 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.96 / $1,193.09 / $1,491.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.09 / $1,172.94 / $2,000.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$952.97 / $1,286.82 / $7,168.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$845.93 / $1,058.51 / $8,440.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.72 / $1,031.76 / $1,937.07