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Louisiana 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
$776.25 / $1,288.25 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,318.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,187.76 / $3,090.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,318.26
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $977.24 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,479.11 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,348.96