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Nebraska 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
$1,122.02 / $7,244.36 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $512.86 / $1,862.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $4,365.16 / $8,511.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $616.60 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $954.99 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $588.84 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $954.99 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,479.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,162.28 / $8,128.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $676.08 / $1,202.26