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Oklahoma 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
$1,000.00 / $3,779.00 / $12,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.12 / $413.75 / $524.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.77 / $1,059.77 / $1,059.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.18 / $436.94 / $714.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.12 / $550.80 / $3,237.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.72 / $547.54 / $3,776.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.00 / $1,928.00 / $4,012.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.05 / $507.84 / $739.81