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Arizona 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
$1,170.00 / $2,300.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.58 / $767.27 / $1,735.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,211.19 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.02 / $1,008.18 / $1,146.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.00 / $865.37 / $1,483.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.50 / $888.43 / $2,065.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.32 / $896.41 / $6,368.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.00 / $2,405.00 / $4,850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.57 / $809.28 / $1,561.19