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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
$933.25 / $4,897.79 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,548.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $8,317.64 / $10,471.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $758.58 / $1,230.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $741.31 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $812.83 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $3,715.35 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $724.44 / $1,288.25