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Maine rates for HCPCS 21400

Closed treatment of fracture of orbit, except blowout; without manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.94 / $178.13 / $256.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.26 / $222.92 / $308.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.79 / $300.82 / $439.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.82 / $275.76 / $489.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.13 / $177.47 / $256.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.72 / $256.86 / $447.19