go back

Pennsylvania rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.16 / $2,679.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.34 / $651.17 / $937.10
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.95 / $713.91 / $713.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$959.91 / $959.91 / $959.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.26 / $747.82 / $1,288.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.25 / $1,105.60 / $1,434.06
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.00 / $2,679.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.14 / $730.24 / $2,605.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.00 / $392.00 / $1,647.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$959.91 / $959.91 / $959.91
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.57 / $762.06 / $1,295.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.11 / $570.38 / $684.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.06 / $614.10 / $739.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.00 / $2,391.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.62 / $781.79 / $1,330.07