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Nebraska 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
$4,241.22 / $11,611.47 / $24,068.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.56 / $919.56 / $5,331.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.01 / $1,505.14 / $2,006.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.00 / $2,247.84 / $3,013.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.56 / $1,609.23 / $8,632.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.81 / $2,045.49 / $2,798.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,180.25 / $2,213.23 / $3,013.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,529.60 / $2,008.88 / $3,013.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.81 / $1,936.13 / $2,663.89