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Tennessee rates for HCPCS 21497

Interdental Wiring Other Than Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$638.62 / $2,303.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.72 / $683.23 / $1,109.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.00 / $2,161.00 / $2,948.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.66 / $884.72 / $1,388.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.02 / $872.30 / $1,333.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,055.28 / $4,155.96 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,268.32 / $5,117.68 / $5,961.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,157.00 / $2,260.00 / $4,035.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.97 / $778.10 / $1,389.22