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Arizona 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
$1,737.80 / $3,090.30 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $2,398.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,778.28 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,202.26 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $870.96 / $1,548.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,000.00 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,047.13 / $7,079.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,041.74 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $1,380.38