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Alaska rates for HCPCS 21485

Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,147.73 / $7,340.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.05 / $3,642.66 / $4,413.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,852.77 / $2,250.06 / $4,244.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.09 / $3,642.66 / $6,178.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,871.25 / $2,744.28 / $5,514.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,773.10 / $3,817.80 / $5,047.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.05 / $3,751.32 / $6,178.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.25 / $3,562.65 / $4,841.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,151.36 / $3,687.28 / $4,732.99