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Arkansas rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.00 / $1,397.00 / $4,478.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.23 / $1,056.21 / $1,322.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,893.49 / $2,893.49 / $3,472.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.74 / $1,058.42 / $1,120.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,337.37 / $4,337.37 / $4,337.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.56 / $1,312.65 / $1,519.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $2,667.00 / $6,957.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.07 / $1,140.94 / $1,663.47