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Tennessee 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
$623.77 / $2,652.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.77 / $452.86 / $686.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.00 / $2,271.00 / $3,441.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.01 / $533.22 / $880.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.00 / $533.37 / $908.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,303.52 / $2,341.67 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,417.76 / $3,668.00 / $4,340.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.00 / $2,297.00 / $4,099.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.17 / $558.61 / $1,069.78