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Iowa rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,496.00 / $4,964.00 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.82 / $1,259.58 / $1,380.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.80 / $1,847.41 / $2,288.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.85 / $1,151.06 / $2,865.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,259.58 / $2,070.56 / $8,328.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.52 / $1,740.75 / $6,294.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.97 / $2,044.07 / $2,571.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.00 / $1,835.48 / $2,402.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,221.00 / $8,060.00 / $11,869.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.96 / $1,283.50 / $2,406.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.83 / $1,547.90 / $1,821.10