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Maine rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.57 / $734.74 / $879.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.54 / $765.15 / $1,116.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.00 / $1,034.29 / $1,511.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.42 / $885.93 / $1,556.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.57 / $734.74 / $879.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,962.56 / $2,962.56 / $2,962.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.16 / $987.81 / $1,408.19