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West 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
$742.42 / $1,078.58 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.42 / $895.93 / $1,064.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.07 / $775.70 / $910.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.24 / $808.94 / $808.94
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
$694.56 / $943.76 / $1,876.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.36 / $719.70 / $1,307.89