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Pennsylvania rates for HCPCS 21408

Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$935.68 / $2,747.00 / $8,247.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.82 / $895.38 / $1,317.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.13 / $935.13 / $1,646.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.38 / $1,017.38 / $1,017.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.20 / $1,105.16 / $1,818.17
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,062.52 / $1,434.41 / $1,835.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$935.68 / $4,761.00 / $8,427.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.82 / $941.14 / $4,460.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.70 / $1,020.70 / $1,845.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.38 / $1,017.38 / $1,017.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.78 / $1,111.69 / $1,860.65
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.15 / $882.15 / $882.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.68 / $885.86 / $934.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.95 / $1,079.61 / $1,715.18