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Massachusetts 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
$794.33 / $2,238.72 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $2,041.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,398.83 / $4,897.79
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,122.02 / $2,818.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,202.26 / $2,238.72
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,548.82 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,258.93 / $1,737.80
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,630.78 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,318.26 / $2,238.72
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,398.83 / $4,897.79
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,122.02 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,630.78 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,122.02 / $2,344.23