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Maryland 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
Professional
Modifier
Low / Median / High Price
$610.67 / $860.68 / $1,059.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.85 / $919.18 / $1,015.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.00 / $453.73 / $620.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.13 / $986.96 / $2,071.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$974.48 / $1,265.35 / $1,742.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.00 / $215.00 / $471.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.16 / $865.74 / $1,746.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.62 / $1,128.03 / $1,392.12