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Tennessee 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
$1,500.00 / $4,069.00 / $10,746.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.75 / $1,025.05 / $1,615.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,014.00 / $6,138.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.84 / $1,322.03 / $2,086.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.95 / $1,350.16 / $2,118.73
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $13,960.05 / $13,960.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,440.44 / $8,440.44 / $8,560.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.73 / $1,113.04 / $2,082.23