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South Carolina rates for HCPCS 21497

Interdental Wiring Other Than Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.92 / $4,230.00 / $9,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.73 / $668.92 / $971.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.58 / $4,057.00 / $6,811.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.00 / $561.66 / $875.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.00 / $780.00 / $1,074.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.75 / $849.67 / $1,503.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.79 / $796.01 / $1,363.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.05 / $829.05 / $829.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.36 / $480.02 / $900.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.00 / $4,877.00 / $9,900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.66 / $746.76 / $1,571.13