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Connecticut rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,862.00 / $6,653.00 / $9,583.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.54 / $942.96 / $2,254.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,217.00 / $10,956.00 / $15,501.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$764.63 / $1,581.25 / $2,327.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.00 / $3,820.70 / $3,820.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.67 / $1,531.85 / $2,212.44
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,330.14 / $4,873.00 / $4,974.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.82 / $1,349.30 / $1,571.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,644.00 / $8,468.00 / $13,943.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.82 / $1,326.42 / $2,335.87