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Massachusetts 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
$691.83 / $2,818.38 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $2,089.30
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $2,754.23 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,148.15 / $3,162.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,288.25 / $2,570.40
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,778.28 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,819.70
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,630.78 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,513.56 / $2,630.27
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,754.23 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,148.15 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,630.78 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,202.26 / $2,630.27