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Idaho rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,897.00 / $4,500.00 / $7,761.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.66 / $1,322.02 / $1,633.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.04 / $1,674.04 / $1,678.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.11 / $1,258.95 / $1,528.01
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.64 / $1,599.85 / $2,020.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.33 / $1,404.36 / $1,868.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,129.76 / $1,421.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,803.94 / $7,766.93 / $9,755.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,267.08 / $1,572.27 / $1,868.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.26 / $1,262.70 / $1,902.28