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New York 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
$778.99 / $2,952.00 / $8,134.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.63 / $860.68 / $1,624.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,385.00 / $4,133.00 / $9,074.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.01 / $959.82 / $1,812.15
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,131.52 / $1,716.00 / $6,213.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.52 / $1,131.52 / $1,387.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,243.82 / $1,243.82 / $1,243.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.71 / $1,114.73 / $3,006.12
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.00 / $440.00 / $1,999.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.38 / $1,429.58 / $2,100.57
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.47 / $872.47 / $872.47
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.07 / $1,140.26 / $2,011.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $1,243.82
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.61 / $1,180.81 / $2,890.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,768.00 / $3,961.00 / $8,312.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.15 / $1,087.48 / $2,723.15
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$932.56 / $932.56 / $1,617.48
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.98 / $1,215.86 / $2,011.44