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New Mexico rates for HCPCS 21395

Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $7,838.38 / $8,942.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.91 / $1,025.69 / $3,569.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.46 / $1,433.19 / $1,833.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,564.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.78 / $1,200.78 / $2,040.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.06 / $1,480.96 / $2,482.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.88 / $1,449.00 / $2,212.19