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Rhode Island 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
$3,981.07 / $3,981.07 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,380.38 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $2,238.72