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Idaho 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
$1,412.54 / $2,137.96 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $977.24 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,659.59 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $1,412.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,174.90 / $2,089.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $1,778.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,467.37 / $4,786.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,445.44 / $1,778.28
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,230.27 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $3,467.37 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,071.52 / $1,584.89