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Arizona rates for HCPCS 21497

Interdental Wiring Other Than Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.50 / $2,897.00 / $6,483.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.20 / $639.39 / $1,421.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,211.19 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.13 / $840.42 / $955.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.54 / $729.16 / $1,244.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.75 / $740.34 / $2,086.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.66 / $766.44 / $5,257.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,283.00 / $2,405.00 / $4,850.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.50 / $702.57 / $1,297.14