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New Mexico rates for HCPCS 21110

Application of interdental fixation device for conditions other than fracture or dislocation, includes removal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,318.26 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $812.83 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,000.00 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,000.00 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $707.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $870.96 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,047.13 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $4,265.80 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,023.29 / $1,479.11