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Tennessee 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
$575.44 / $2,290.87 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,187.76 / $2,951.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,000.00 / $1,584.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $4,897.79 / $4,897.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $7,079.46 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,290.87 / $4,073.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,479.11