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Missouri 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
$1,760.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.78 / $1,018.80 / $1,593.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.31 / $1,163.90 / $1,799.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.19 / $1,321.27 / $2,201.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.30 / $1,560.00 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.86 / $1,394.07 / $8,440.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.66 / $1,290.88 / $2,188.25