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Maryland rates for HCPCS 21395

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.97 / $1,025.05 / $1,136.75
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.59 / $1,096.79 / $1,228.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $507.00 / $641.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.91 / $1,256.24 / $2,304.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.94 / $1,358.15 / $1,770.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.30 / $1,109.91 / $2,113.67
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.27 / $1,210.75 / $1,490.66