go back

Missouri rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.89 / $3,213.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.29 / $654.28 / $940.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,279.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.83 / $621.71 / $996.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.96 / $824.42 / $1,319.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.38 / $882.88 / $2,672.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.62 / $1,000.46 / $5,257.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $2,136.00 / $2,962.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.88 / $830.89 / $1,444.87