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Georgia rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,352.00 / $5,045.00 / $6,915.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.96 / $871.82 / $1,950.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$878.93 / $2,533.21 / $5,240.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.75 / $1,205.10 / $2,112.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,378.13 / $1,652.33 / $2,247.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.23 / $897.23 / $1,918.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.13 / $1,398.61 / $2,030.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.85 / $1,325.65 / $2,073.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,738.00 / $7,794.00 / $14,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.50 / $1,231.93 / $1,868.94