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Indiana rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.78 / $560.46 / $5,634.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.00 / $3,677.00 / $5,445.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.59 / $41.25 / $65.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.79 / $172.79 / $204.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$866.00 / $2,291.00 / $4,426.00