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Michigan 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
$1,288.50 / $4,933.00 / $6,853.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.38 / $1,286.82 / $1,338.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,968.13 / $5,831.13 / $7,900.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.44 / $1,438.64 / $2,385.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.61 / $1,110.52 / $2,151.29
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,001.88 / $4,933.00 / $6,853.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.72 / $1,122.09 / $1,621.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.66 / $683.30 / $1,160.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.91 / $1,164.35 / $1,666.96