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Georgia rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $5,370.32 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $912.01 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $2,454.71 / $4,786.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,380.38 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,348.96 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,288.25 / $2,041.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $6,456.54 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,174.90 / $1,819.70