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Georgia rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.31 / $2,800.00 / $6,915.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$291.20 / $291.20 / $307.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.46 / $2,067.41 / $3,851.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.15 / $66.05 / $138.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $54.34 / $640.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $155.72 / $248.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $1,550.00 / $2,665.00