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South Carolina rates for HCPCS 21497

Interdental wiring, for condition other than fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,258.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,801.89 / $7,079.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $588.84 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $776.25 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $851.14 / $1,412.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,659.59
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $645.65 / $1,071.52