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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
$746.34 / $2,507.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.19 / $795.40 / $1,143.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.35 / $720.99 / $1,140.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.37 / $974.06 / $1,599.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.25 / $1,007.43 / $2,216.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.22 / $1,207.04 / $6,368.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $2,136.00 / $2,831.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.65 / $997.54 / $1,740.35