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Vermont rates for HCPCS 21395

Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,380.38 / $2,290.87
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,445.44 / $4,168.69