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Pennsylvania 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
$1,445.44 / $7,244.36 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $2,630.27
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,202.26 / $1,995.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,445.44 / $1,819.70
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,174.90 / $1,905.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $5,754.40 / $11,220.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $2,951.21
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $2,041.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,348.96 / $2,089.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $933.25 / $977.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,905.46