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Illinois rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $1,096.48 / $5,623.41
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$416.87 / $416.87 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $363.08 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $194.98 / $467.74
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $724.44 / $2,187.76