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Texas 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
$752.04 / $2,594.00 / $7,495.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.80 / $883.87 / $1,348.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,181.16 / $2,145.44 / $4,155.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.23 / $973.94 / $2,111.58
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $742.47 / $742.47
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
$658.91 / $985.52 / $1,524.90
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,296.32 / $11,500.00 / $16,394.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,560.64 / $6,786.96 / $7,942.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.96 / $834.91 / $1,440.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$973.05 / $1,235.03 / $1,646.57
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.30 / $361.30 / $361.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.71 / $836.09 / $1,480.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.06 / $1,026.70 / $1,714.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.00 / $2,064.00 / $4,509.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.38 / $818.84 / $1,346.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.72 / $872.76 / $1,241.57