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Louisiana 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
$660.69 / $1,513.56 / $4,168.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,818.38 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,479.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,000.00 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,479.11 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $794.33 / $1,412.54