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Pennsylvania 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
$831.76 / $2,691.53 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $831.76 / $1,698.24
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,691.53 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,000.00 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $1,548.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $1,819.70
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,023.29 / $1,445.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $5,011.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,344.23 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,000.00 / $2,238.72
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,862.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $549.54 / $1,819.70
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $575.44 / $831.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $616.60 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $2,630.27 / $5,495.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $851.14 / $1,445.44