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Wisconsin rates for HCPCS 21110

Appl Interdental Fixation Device Non-Fx/Dislc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$718.39 / $1,467.99 / $3,153.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.72 / $866.71 / $3,342.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.44 / $1,657.83 / $4,481.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,554.79 / $1,554.79 / $1,554.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,323.09 / $2,714.71 / $4,164.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.85 / $2,534.98 / $3,960.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.25 / $927.82 / $1,779.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.10 / $1,077.58 / $4,292.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.48 / $1,815.68 / $6,368.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.96 / $495.58 / $1,630.05
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.10 / $905.32 / $1,779.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.12 / $2,021.98 / $2,899.19
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.82 / $1,258.82 / $5,021.52
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.93 / $3,668.85 / $6,368.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.63 / $4,595.20 / $5,546.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,883.00 / $3,827.00 / $6,564.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.48 / $1,565.52 / $3,601.88