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New Mexico rates for HCPCS 21400

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.66 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.94 / $200.55 / $277.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.82 / $245.30 / $345.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $36.66 / $308.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.97 / $200.17 / $273.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.67 / $255.88 / $439.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.41 / $282.73 / $406.07