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Idaho rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $3,162 · 10th–90th $1,000$8,3180%10%10th90th$3,162Professionalmedian $1,259 · 10th–90th $794$1,6980%10%10th90th$1,259$50.0$200.0$1.0K$5.0K$20.0K

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
$2,884.03 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,047.13 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $5,248.07 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,548.82 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,122.02 / $1,513.56
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,318.26 / $2,238.72
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,318.26 / $1,905.46
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $7,585.78 / $10,232.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,584.89 / $1,778.28
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $912.01 / $8,317.64
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $10,232.93 / $27,542.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,230.27 / $1,905.46