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Pennsylvania rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.44 / $1,644.06 / $6,012.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,305.00 / $1,701.08 / $1,701.08
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.51 / $1,395.00 / $12,759.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $54.34 / $54.34
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.36 / $941.36 / $1,116.24
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$192.80 / $839.20 / $1,654.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,741.00 / $7,197.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,305.00 / $1,305.00 / $1,701.08
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $54.34 / $54.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.68 / $57.00 / $146.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.00 / $557.00 / $3,742.00