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Louisiana 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
$492.18 / $1,850.00 / $3,884.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.68 / $520.94 / $804.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,330.58 / $2,754.68 / $4,536.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.70 / $541.96 / $795.94
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $306.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.11 / $546.97 / $850.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,123.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.18 / $549.40 / $1,004.64