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Maine 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
$618.12 / $897.89 / $1,132.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.75 / $951.47 / $1,268.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.41 / $1,358.82 / $2,083.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.83 / $1,170.73 / $2,069.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.12 / $809.54 / $1,132.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.58 / $1,000.80 / $1,931.52