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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
$761.32 / $2,070.00 / $7,197.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.11 / $782.99 / $1,107.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.41 / $857.59 / $857.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.71 / $1,151.71 / $1,151.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.10 / $884.09 / $1,505.50
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.37 / $1,325.04 / $1,719.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,547.36 / $2,547.36 / $5,000.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.32 / $2,326.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.51 / $851.83 / $2,732.72
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.00 / $486.00 / $1,861.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.71 / $1,151.71 / $1,151.71
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.68 / $909.71 / $1,560.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.29 / $693.78 / $833.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.54 / $745.94 / $900.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $2,113.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.08 / $966.74 / $1,602.75