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Utah 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
$1,071.52 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $912.01 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $954.99 / $1,778.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,288.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $5,888.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,348.96 / $1,905.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,318.26 / $1,621.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,174.90 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $776.25 / $1,202.26