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Idaho rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.07 / $980.39 / $1,471.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.18 / $789.18 / $791.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.12 / $994.02 / $1,216.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.44 / $1,035.97 / $1,618.68
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.75 / $1,135.74 / $1,387.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $979.63 / $1,232.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,734.94 / $3,749.50 / $4,629.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.35 / $1,202.73 / $1,470.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.00 / $2,962.56 / $7,609.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.80 / $1,019.21 / $1,491.34