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Montana 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
$707.95 / $1,047.13 / $2,570.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,000.00 / $1,348.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,318.26 / $1,548.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,318.26 / $1,548.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $954.99 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,122.02 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $1,548.82