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Maine rates for HCPCS 21387

Open Tx Orbital Floor Blowout Fx Combined Appr

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.86 / $810.04 / $990.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.97 / $1,037.84 / $1,464.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.00 / $1,174.90 / $1,659.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.72 / $1,106.92 / $1,698.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.86 / $876.25 / $990.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.82 / $1,000.89 / $1,528.76