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Colorado rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,768.00 / $5,503.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.18 / $801.50 / $1,121.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,434.00 / $5,126.00 / $9,729.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.95 / $1,114.15 / $1,773.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,997.28 / $1,997.28 / $6,291.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.38 / $1,190.18 / $1,647.25
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.50 / $1,174.88 / $1,442.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.92 / $1,150.66 / $1,587.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,251.00 / $11,924.00 / $19,712.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.26 / $1,218.08 / $1,865.58