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New Mexico rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.30 / $7,838.38 / $8,644.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.37 / $641.30 / $1,031.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,369.57 / $30,689.52 / $50,008.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.92 / $938.05 / $1,234.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $977.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.77 / $820.99 / $1,455.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.68 / $1,000.95 / $1,537.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.15 / $975.00 / $1,494.44