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Washington, DC rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.00 / $3,999.00 / $6,456.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.50 / $803.50 / $803.50
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.76 / $833.76 / $4,930.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.38 / $1,349.30 / $2,126.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.48 / $1,782.33 / $1,782.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.16 / $1,219.36 / $2,157.92