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Indiana 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
$306.66 / $834.00 / $11,093.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.16 / $413.75 / $521.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,140.00 / $5,948.00 / $9,462.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.85 / $313.99 / $433.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.26 / $423.11 / $634.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.50 / $573.13 / $825.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.00 / $881.00 / $1,044.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.39 / $450.00 / $772.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,874.00 / $5,490.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.85 / $533.40 / $934.15