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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
$908.64 / $2,145.78 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.54 / $908.64 / $1,696.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.62 / $3,378.27 / $5,793.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.35 / $986.35 / $1,170.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.41 / $1,001.89 / $1,432.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $141.75 / $1,181.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.60 / $742.45 / $997.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.25 / $1,095.97 / $1,872.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.00 / $3,085.00 / $5,060.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.44 / $1,179.49 / $1,673.10