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New Hampshire 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
$1,949.84 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,258.93 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,412.54 / $2,570.40
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,258.93 / $2,398.83
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,230.27