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Texas rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.86 / $1,934.00 / $6,691.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$83.52 / $692.30 / $692.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.14 / $345.02 / $769.83
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.27 / $241.15 / $667.73
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.80 / $29.80 / $80.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $54.34 / $54.34
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.77 / $11,500.00 / $12,000.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.04 / $101.22 / $187.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.04 / $101.22 / $188.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $1,058.00 / $2,668.00