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Virginia rates for HCPCS 21480

Closed treatment of temporomandibular dislocation; initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.06 / $1,719.00 / $5,743.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,204.02 / $3,204.02 / $3,204.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $54.34 / $420.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.63 / $174.24 / $205.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.63 / $107.90 / $204.10
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$111.10 / $214.50 / $484.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.74 / $41.56 / $546.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.00 / $819.00 / $2,364.00