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Illinois 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
$933.25 / $1,862.09 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $933.25 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,691.53 / $16,982.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,479.11 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,047.13 / $1,584.89
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $1,258.93 / $1,659.59
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $933.25 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,290.87 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $1,548.82