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California rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.98 / $5,505.00 / $16,713.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.77 / $660.07 / $3,104.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.00 / $5,863.00 / $11,400.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.52 / $769.49 / $1,637.12
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $7,100.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.45 / $555.02 / $1,286.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.00 / $1,293.28 / $2,312.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.99 / $816.30 / $1,708.65
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.57 / $748.86 / $1,010.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.57 / $881.27 / $1,428.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,055.28 / $4,155.96 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,268.32 / $5,117.68 / $5,961.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.44 / $851.90 / $1,220.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.40 / $882.49 / $1,780.53
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,926.03 / $1,926.03 / $2,310.71
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.55 / $605.44 / $1,014.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,152.00 / $4,060.00 / $10,621.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.20 / $695.34 / $1,596.87