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Iowa rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $3,981.07 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,862.09 / $2,344.23
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,071.52 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,089.30 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,698.24 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,819.70 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $8,511.38 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,258.93 / $2,398.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $1,819.70