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Texas rates for HCPCS 21497

Interdental Wiring Other Than Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.00 / $2,500.00 / $7,495.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.19 / $676.44 / $1,020.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.94 / $2,131.96 / $4,144.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.70 / $697.80 / $1,096.70
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $543.09 / $543.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$959.91 / $959.91 / $959.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.72 / $813.15 / $1,297.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,055.28 / $11,500.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,268.32 / $5,117.68 / $5,961.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.41 / $722.75 / $1,187.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.13 / $945.75 / $1,238.99
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.20 / $414.20 / $414.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.80 / $726.37 / $1,259.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.86 / $877.20 / $1,364.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.00 / $2,478.00 / $4,739.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.37 / $732.49 / $1,140.97
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.47 / $658.56 / $933.90