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Illinois 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
$741.31 / $1,862.09 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,691.53 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,122.02 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,000.00 / $1,513.56
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,202.26 / $2,290.87
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,290.87 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,479.11