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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
$838.10 / $1,449.38 / $4,806.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.05 / $1,234.05 / $1,234.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.26 / $1,048.94 / $1,359.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.83 / $748.14 / $1,234.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.69 / $1,284.03 / $1,863.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$974.97 / $1,386.55 / $1,597.81