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Hawaii rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $4,467 · 10th–90th $1,778–$4,4670%50%10th$4,467Professionalmedian $1,380 · 10th–90th $776–$5,7540%10%10th90th$1,380$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $4,466.84 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $912.01 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,071.52 / $1,202.26
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,380.38 / $5,248.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $870.96 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,023.29 / $1,348.96
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $3,235.94 / $6,165.95