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Virginia 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
$551.32 / $3,988.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.66 / $451.60 / $638.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.94 / $393.79 / $651.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.23 / $361.23 / $4,117.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.65 / $557.65 / $640.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.57 / $516.07 / $944.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.96 / $634.05 / $749.35
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.51 / $551.32 / $894.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.00 / $685.65 / $952.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.04 / $401.56 / $1,406.53
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.28 / $629.23 / $1,683.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,713.00 / $2,863.00 / $5,340.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.41 / $591.60 / $984.02