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Maine rates for HCPCS 21110

Application of interdental fixation device for conditions other than fracture or dislocation, includes removal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $2,041.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,071.52 / $1,862.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,096.48 / $2,290.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $977.24 / $1,737.80