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Illinois 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
$588.84 / $2,290.87 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $489.78 / $954.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,398.83 / $7,244.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $537.03 / $891.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $741.31 / $1,819.70
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $416.87 / $691.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,290.87 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $489.78 / $891.25