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New Mexico rates for HCPCS 21421

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,000.00 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $8,912.51 / $14,125.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $758.58 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $912.01 / $2,238.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $537.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,258.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $933.25 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $6,606.93 / $14,454.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $912.01 / $1,318.26