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Idaho rates for HCPCS 21401

Closed treatment of fracture of orbit, except blowout; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $524.81 / $933.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,949.84 / $3,981.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $562.34 / $870.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $630.96 / $1,202.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $812.83 / $1,096.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,467.37 / $4,786.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $707.95 / $1,071.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $575.44 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $3,467.37 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $562.34 / $912.01