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Nebraska rates for HCPCS 21401

Closed Tx Fx Orbit Except Blowout W/Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$471.67 / $8,042.03 / $19,276.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.43 / $471.67 / $1,715.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,350.61 / $4,406.97 / $8,524.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.73 / $610.34 / $958.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$986.07 / $986.07 / $986.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.93 / $955.37 / $1,479.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.50 / $585.78 / $1,843.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.35 / $1,009.41 / $2,457.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.97 / $1,078.19 / $1,494.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.89 / $934.96 / $1,379.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $3,726.00 / $7,934.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.35 / $1,037.55 / $1,315.24