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Montana 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
$776.25 / $1,047.13 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $1,000.00 / $1,348.96
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $1,698.24
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $1,698.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $933.25 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,122.02 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,202.26 / $1,621.81