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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
$757.41 / $1,281.33 / $4,474.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,121.01 / $1,121.01 / $1,121.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.39 / $1,008.91 / $1,351.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.26 / $726.66 / $1,121.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.56 / $1,167.91 / $1,652.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,033.09 / $1,033.09 / $1,033.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.72 / $1,321.03 / $1,537.13