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Indiana 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
$744.03 / $1,174.69 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.17 / $849.10 / $1,060.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,943.00 / $5,126.00 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.66 / $736.65 / $1,046.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.98 / $1,042.61 / $1,459.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.37 / $1,060.46 / $1,527.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.00 / $881.00 / $1,044.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.86 / $814.46 / $1,312.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $3,874.00 / $5,490.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.30 / $818.84 / $1,546.01