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Utah rates for HCPCS 21497

Interdental Wiring Other Than Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.93 / $3,038.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.70 / $801.93 / $3,104.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.41 / $863.28 / $1,291.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.74 / $401.61 / $644.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,237.82 / $2,891.57 / $4,213.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.46 / $1,033.61 / $1,793.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.00 / $4,455.00 / $4,912.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.69 / $744.80 / $1,182.67