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Arizona rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.00 / $3,819.00 / $7,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.96 / $801.50 / $4,401.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.35 / $2,531.19 / $4,140.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.06 / $950.93 / $1,188.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.47 / $1,029.66 / $1,659.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.27 / $1,041.46 / $7,167.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.64 / $954.00 / $6,294.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.99 / $903.26 / $1,589.04