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Maine rates for HCPCS 21401

Closed treatment of fracture of orbit, except blowout; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $478.63 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $489.78 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $602.56 / $1,047.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $691.83 / $1,230.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $602.56 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $512.86 / $1,071.52