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North Carolina 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
$987.03 / $1,615.00 / $15,291.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.03 / $1,037.40 / $1,933.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.94 / $1,512.61 / $2,656.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.22 / $1,372.75 / $2,534.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$987.03 / $1,180.96 / $2,230.69
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.96 / $1,262.00 / $1,291.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $1,307.30 / $2,634.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$854.57 / $1,245.94 / $2,474.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $11,953.99 / $13,960.05
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,440.44 / $8,440.44 / $8,560.50