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Missouri 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 / $2,511.89 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $2,137.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $4,677.35 / $8,912.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $741.31 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $954.99 / $1,584.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,023.29 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,202.26 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,202.26 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,445.44