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South Carolina 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
$1,096.48 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,801.89 / $7,079.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $776.25 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $776.25 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $912.01 / $1,737.80
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $2,290.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $933.25 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $1,258.93