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Washington rates for HCPCS 21480

Closed Tx Temporomandibular Dislocation 1st/Sbsq

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.75 / $347.87 / $13,750.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$820.26 / $890.90 / $890.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.77 / $668.30 / $2,000.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$761.70 / $1,002.45 / $1,939.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.39 / $500.00 / $568.48
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.32 / $118.81 / $279.33
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$284.85 / $759.95 / $1,828.44
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.72 / $223.78 / $284.75
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.31 / $191.17 / $232.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.36 / $667.91 / $1,278.36
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$650.04 / $1,001.87 / $1,917.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.00 / $648.00 / $5,793.00