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Pennsylvania rates for HCPCS 21485

Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent

Facilitymedian $3,802 · 10th–90th $1,047–$8,3180%10%10th90th$3,802Professionalmedian $871 · 10th–90th $617–$1,5140%20%10th90th$871$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $3,890.45 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $870.96 / $1,445.44
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,466.84 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $954.99 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $851.14 / $1,659.59
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,659.59 / $2,089.30
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $1,096.48 / $1,621.81
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $2,570.40 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $870.96 / $1,548.82
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $1,122.02 / $1,949.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $416.87 / $933.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $758.58 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,818.38 / $5,495.41
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $870.96 / $1,548.82