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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
$593.00 / $1,372.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.04 / $1,035.94 / $1,347.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,330.58 / $2,754.68 / $4,536.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.94 / $1,080.51 / $1,342.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $742.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$725.00 / $725.00 / $725.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.98 / $1,032.36 / $1,544.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,123.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.04 / $866.50 / $1,530.45