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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
$691.83 / $933.25 / $1,905.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,122.02 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,174.90 / $2,089.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,258.93 / $2,630.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,096.48 / $2,344.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $954.99 / $1,949.84