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Michigan 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
$1,202.26 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $1,148.15 / $1,148.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $831.76 / $1,737.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $2,884.03 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,258.93
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $812.83 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $2,951.21 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,122.02