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New York 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
$912.01 / $2,818.38 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,995.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,786.30 / $10,232.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,995.26
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $8,912.51
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $1,148.15 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,122.02 / $3,090.30
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $831.76 / $2,137.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,412.54 / $1,995.26
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,096.48 / $1,819.70
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,511.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,096.48 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $3,890.45 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $891.25 / $2,290.87
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $851.14 / $2,511.89
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,071.52 / $1,995.26