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Massachusetts 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
$2,691.53 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $2,630.27
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $3,981.07 / $13,803.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,513.56 / $8,511.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,479.11 / $2,818.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,949.84 / $7,762.47
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,258.93 / $1,737.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,737.80 / $2,818.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $3,981.07 / $13,803.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,513.56 / $8,511.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,513.56 / $2,818.38