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South Carolina 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
$977.24 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,778.28 / $3,162.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $954.99 / $1,737.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $2,041.74
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $933.25 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $776.25 / $1,202.26