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Virginia 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
$933.25 / $3,235.94 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,621.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,981.07 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,122.02 / $1,905.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,202.26 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $912.01 / $1,819.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $1,513.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $758.58 / $2,290.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $954.99 / $1,548.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $346.74
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $812.83 / $3,388.44
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $977.24 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,311.31 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $794.33 / $1,584.89